Severe pancreaticoduodenal trauma: review of a series of 30 patients]

Retrospective study of a series of 30 patients (mean age: 25.5 years), including 8 children with severe duodenopancreatic trauma, treated over a period of 15 years. This series consisted of 14 cases of duodenal perforation, 3 cases of duodenal haematoma, 11 cases of isolated pancreatic lesions (including 5 isthmic ruptures) and 2 cases of associated duodenal and pancreatic lesions. Injuries were due to road accidents in 60% of cases. Eight patients were considered to have multiple injuries. Twelve patients required emergency surgery. Eighteen were observed in a surgical unit. Two duodenal haematomas were operated. Duodenal perforations were operated urgently in 8 cases and electively in 6 cases. The surgical procedure consisted of simple suture (n = 3), suture combined with diversion (n = 7), or resection-anastomosis (n = 4). Five patients with pancreatic contusion were operated, in a context of acute pancreatitis in four cases and for associated lesions in one case. Isthmic ruptures were treated by left pancreatic resection. This was a rare lesion (1.8 to 9% of organ lesions). Duodenal haematomas justify first-line medical treatment, while duodenal perforations must be operated. The presence of a lesion of the pancreatic duct frequently justifies pancreatic resection.