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Pancreatic trauma

Key sources
The following summarized guidelines for the evaluation and management of pancreatic trauma are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES/AAST 2019).
1

Guidelines

1.Diagnostic investigations

Ultrasound
Obtain eFAST for detecting free fluid and solid organ injury.
A
Do not obtain routine ultrasound for the diagnosis of duodeno-pancreatic trauma. Consider obtaining contrast-enhanced ultrasound in stable patients with trauma with suspected pancreatic injury.
D
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  • Abdominal radiography

  • CT

  • MRCP

  • Hepatobiliary scintigraphy

  • Pancreatic enzymes

2.Diagnostic procedures

Endoscopic retrograde cholangiopancreatography: consider performing ERCP for both diagnosis and treatment in hemodynamically stable or stabilized adult and pediatric patients with suspected pancreatic duct and extrahepatic biliary tree injuries, even in the early phase after trauma.
B

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  • Peritoneal lavage

3.Medical management

Nonoperative management: offer nonoperative management in all hemodynamically stable or stabilized patients with minor pancreatic injury (WSES class I, AAST grade I and some grade II) and gallbladder hematomas without perforation (WSES class I, AAST grade I) in the absence of other abdominal injuries requiring surgery.
B
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4.Surgical interventions

Exploratory laparotomy: perform exploratory laparotomy in hemodynamically unstable (WSES class IV) patients with a positive eFAST.
A
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  • Indications for surgery

5.Specific circumstances

Pediatric patients: prefer MRI if available in the emergency setting to detect pancreatic parenchymal or pancreatic duct lesions in pediatric patients.
B
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  • Pregnant patients

  • Patients with duodenal injury (nonoperative management)

  • Patients with duodenal injury (operative management)

6.Follow-up and surveillance

Serial clinical assessment: perform serial clinical examination during follow-up after biliary and pancreatic-duodenal trauma.
B

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  • Serial imaging assessment