The pancreas cont d

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.
If the gland is transected in the body or tail, a distal pancreatectomy should be performed, with or without splenectomy. If damage is purely confined to the head of the pancreas, haemostasis and external drainage is normally effective. However, if there is severe injury to the pancreatic head and duodenum, then a pancreatoduodenectomy may be necessarya).
Pancreatic fistula
Pancreatic fistula usually follows operative trauma to the gland or occurs as a complication of acute or chronic pancreatitis.
Management of pancreatic fistulae
_ Tests Measure amylase level in fluid Determine the anatomy of the fistula Check whether the main pancreatic duct is blocked or disrupted
_ Measures Correct fluid and electrolyte imbalances Protect the skin Drain adequately Parenteral or nasojejunal feeding Octreotide to suppress secretion Relieve pancreatic duct obstruction if possible (ERCP and stent)
Treat underlying cause