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