Blunt pancreatic trauma: prospective evaluation of early endoscopic retrograde pancreatography

Major ductal injury is a determining factor in the outcome after pancreatic trauma. The purpose of this study was to determine the value of early endoscopic retrograde pancreatography (ERP) in patients with blunt pancreatic trauma. We attempted ERP in nine patients. Indications were abnormal pancreatic findings on CT scanning in five patients, a suboptimal view on CT scanning in three patients, and a high index of suspicion in one patient. ERP was successful in eight patients. Two had major ductal injury treated operatively and were discharged without complications. In six, ERP showed a normal pancreatic duct. These patients were treated conservatively; five were eventually discharged, and one died of necrotizing pneumonia. Our results suggest that ERP is safe and accurate in the diagnosis of blunt pancreatic ductal injuries. If the pancreatic ductal system is intact, conservative management is appropriate, but if ERP shows major ductal injury, surgical intervention is indicated.