Management of Pancreatic Injuries

Annotation for Point F

Grade I and II. When Grade I and II injuries are discovered  intraoperatively, the vast majority can be treated with no  more than surgical hemostasis and drainage.^18-20 Even capsular  tears that are not bleeding are not repaired and may be  simply drained with closed suction drainage. Drainage is used  liberally because many minor appearing injuries will drain  for several days. Unnecessary attempts at repair of lacerations  without evidence of ductal disruption can result in late  pseudocyst formation, whereas the vast majority of controlled,  minor pancreatic fistulae are self-limited and easily  managed with soft closed suction drains. The drains are  usually removed within a few days, as long as the amylase  concentration in the drain is less than that of serum. If amylase  levels are elevated, drainage is continued until there is  no further evidence of pancreatic leak. Prolonged gastric  ileus is common with even minor pancreatic injuries, so enteral  access with a jejunostomy feeding tube should be considered  in the setting of Grade II injuries or higher. Since  the composition of most standard tube feeding increases  the pancreatic effluent volume and amylase concentration,  lower fat and higher pH (4.5) elemental diets are less stimulating  to the pancreas and are particularly well suited for use  in needle catheter jejunostomies.²¹