Pancreatico-enterostomy for isolated main pancreatic duct disruption

BACKGROUND: We present our experiences with isolated main pancreatic duct injuries due to blunt trauma, managed by pancreatico-enterostomies. METHODS: This is a retrospective study of seven patients, one female and six males who presented between 1997 and 2005, whose ages ranged from 10 to 54 years. Three were due to motor vehicle accidents, two due to blunt assault, one pedestrian vehicle accident and one go-cart accident. Four presented acutely and were managed surgically within 24h; two were delayed by 3 days and one by 14 days. Six had pre-operative CT scans; one had an ERCP confirming ductal transection by contrast extravasation. RESULTS: Five pancreatico-gastrostomies and two pancreatico-jejenostomies were performed. Three patients complicated; one by biliary cutaneous fistula after a left hepatic segmentectomy, one with an amylase-rich low output fistula and one with haematemesis, for which no cause could be identified. All complications were managed conservatively. Post-operative follow-up ranged between 4 and 20 weeks. No deaths occurred. CONCLUSION: In a stable patient, pancreatico-enterostomy for an isolated main pancreatic duct injury appears to be a viable option and simpler to perform than distal pancreatectomy with splenic preservation. Furthermore, it has the advantage of pancreatic tissue and spleen preservation and a low fistula rate. The authors believe pancreatico-gastrostomy to be the easier to perform.