Management of pancreatic injuries

Ho VP, Patel NJ, Bokhari F, et al. Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017 Jan;82(1):185-199. Free-full text.

In summary, we propose the following recommendations:

  1. For adult patients with grade I or II injury to the pancreas identified on CT scan, we conditionally recommend nonoperative management.
  2. For adult patients with grade III or IV injury to the pancreas identified on CT scan, we conditionally recommend operative intervention.
  3. For adult patients with grade I or II injuries to the pancreas who are undergoing an operation, we conditionally recommend non-resectional management.
  4. For adult patients with grade III or IV injuries to the pancreas who are undergoing an operation, we conditionally recommend resectional management.
  5. For adult patients with grade V injuries to the pancreas who are undergoing an operation, we give no recommendation regarding whether a pancreaticoduodenectomy or a surgical procedure other than pancreaticoduodenectomy should be performed.
  6. For adult patients who have undergone an operation for pancreatic trauma, we conditionally recommend against the routine use of octreotide prophylaxis.
  7. For adult patients undergoing a distal pancreatectomy for pancreatic trauma, we give no recommendation regarding whether routine splenectomy or splenic preservation should be performed.