The pancreas cont d

THE PANCREAS
INJURIES TO THE PANCREAS ;External injury Presentation and management
. If there is damage to the pancreas, it is often concomitant with injuries to other viscera, especially the liver,the spleen and the duodenum.The most important factor that determines treatment is whether the pancreatic duct has been disrupted.
Blunt pancreatic trauma usually presents with epigastric pain, which may be minor at first, with the progressive development of more severe pain due to the sequelae of leakage of pancreatic fluid into the surrounding tissues. The clinical presentation can be quite deceptive; careful serial assessments and a high index of suspicion are required. A rise in serum amylase occurs in most cases. A CT scan of the pancreas will delineate the damage that has occurred to the pancreas .. If there is doubt about duct disruption, an urgent ERCP should be sought. Support with intravenous fluids and a nil by mouth regimen should be instituted while these investigations are performed.
Operation is indicated if there is disruption of the main pancreatic duct; in almost all other cases, the patient will recover with conservative management. In penetrating injuries, especially if other organs are injured and the patient’s condition (is unstable, there is a greater need to perform an urgent surgical exploration.