Chapter 32: Duodenum and Pancreas

INTRODUCTION

Injuries to the pancreas and duodenum present a significant challenge, for a number of reasons. First, while their deep, central position affords the organs some degree of protection, their retroperitoneal location compromises the clinical detection of injury. This can lead to delays in diagnosis and treatment, which may result in morbidity and mortality.^{1,2,3,4,5,6,7} Second, even when managed promptly, anatomic and physiologic factors contribute to a disturbingly high incidence of complications. Third, the infrequency of these injuries has resulted in a lack of significant management experience—both of the primary injuries as well as the complications—among practicing trauma surgeons. Consequently, trauma to the pancreas and duodenum is associated with relatively poor outcomes that have not improved significantly over the past few decades, despite advances in trauma and critical care management (Tables 32-1 and 32-2).^{1,3,6,8,9,10,11,12,13,14,15,16,17,18,19}