Pancreatic injuries by the blunt trauma have many difficult problems in surgery. Its obscure clinical findings often delay the diagnosis and operative treatment. In addition, determination of the adequate operation is very puzzling, so the mortality and morbidity increase. Now we have analysed 21 cases of the blunt pancreatic injuries during the last ten years treated at the Seoul National University Hospital and got the result as follows.
1) Blunt pancreatic inruries had three prominent characteristics. First, it showed tendency toward the diagnostic delay due to obscure clinical findings. Second, the detection of the patterns and location of injury was very difficult. Third, the pancreatic fistula and pseudocyst were frequently accompanied after injuries.
2) Eelevation of the serum amylase level has been known as to be nonspecific to the pancreatic injuries. But we found its value of use in two aspects. When both of the serum level measured at the immediate and 6 hours after injury were elevated, and elevating with the sign of aggravating abdominal pain even without any finding of definite peritonitis, it is sure to be one of the indications of operation. On the other hand, in case of the pseudocyst, its continuous elevation had been usually found and might have additive diagnostic value for the detection of it.
3) Blunt pancreatic trauma had tendency toward being accompanied by the injury of posterior pancreatic capsule. So, when the lesion was resectable as much as 85% of pancreas, resection was preferred method for prevention of postoperative complications. When the injury combined duodenal perforation, duodenal diverticulization was thought to be useful. The indication of pancreaticoduodenectomy should be restricted to inevitable condition.
4) Ligation of the main pancreatic duct might not prevent postoperative pancreatic fistula due to the presence of small ducts or ductules. But ligation of the main duct would be necessary for prevention of profuse intraperitoneal drainage of pancreatic juice.
5) Prophylactic use of antibiotic was recommendable according to our bacteriologic result.
6) We statistically examined the prognostic factors and followings showed remarkable significance.: time of operation, existence of the combined duodenal perforation, location of
pancreatic in jury, sepsis. The degree and number of the combined visceral injuries and apancreatic in jury, sepsis. The degree and number of the combined visceral injuries and adequacy of operations might also affect the prognosis. In conclusion, the prompt diagnosis and adequate operation was the most important to the blunt pancreatic injuries and we should always remember that the first purpose of operation was saving of life.dequacy of operations might also affect the prognosis. In conclusion., the prompt diagnosis and adequate operation was the most important to the blunt pancreatic injuries and we should always remember that the first purpose of operation was saving of life.
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