35 Hellenic Journal of Surgery 2010; 82: 6 Abstract Aim-Background: Albeit uncommon, pancreatic trauma is associated with high morbidity and mor- tality and strict criteria for its management is lack- ing. The objective of this study is to review and evaluate the role of intraoperative imaging, current management practice and the potential complica- tions of both the surgical and non-surgical approach in regard to this entity. Methods: The present review pooled the data of studies published in the English literature mainly during the last decade. Fifteen reviews and eleven clinical studies were identified in the following data- bases: medline, pubmed, scholar google, scopus. Results: The patient’s haemodynamic status, integ- rity of the pancreatic duct, site of duct injury and presence of a concomitant duodenal injury are the major determinant factors in deciding final manage- ment. Intraoperative radiological techniques for the evaluation of the pancreatic duct integrity include: i) intraoperative cholangiogram, ii) intraoperative pancreatography by cannulation of the duct and iii) intraoperative Endoscopic Retrograde Cho- langiopancreatography (ERCP) which is the most accurate method for defining ductal injury. The spectrum of pancreatic injuries ranges from simple contusions or lacerations which are managed non- operatively or with external drainage, to major in- juries with disruption of the pancreatic duct which are best treated by pancreatic resection. Complex pancreatoenteral anastomoses have also been advo- cated in the literature but are ill-advised as they are related to high rates of postoperative complications and are particularly time consuming at acute phase. In combined pancreatoduodenal injuries, each or- gan merits its own management depending on the severity of injury, with pancreatoduodenectomy being reserved for pancreatic head maceration and destruction of the ampulla of Vater. 2nd Surgical Department and Surgical Oncology Unit, General Hospital Korgialenio-Benakio Red Cross, Athens-Greece e-mail: markorontzi@gmail.com In our systematic review, the overall morbidity of pancreatic trauma was found to be 40%. Morbidity increased with a higher grade of injury (grade I and II: 27%, grade III: 56%, grade IV and V: 69%). The rate of surgical complications for all grades was 46% (grade I and II: 7%, grade III: 57%, grade IV,V: 67%). The Non-Operative Management (NOM) morbidity rate for all grades of injury was found to be 33%. NOM is mainly reserved for low grade injuries and haemodynamically stable patients with no concomitant injuries. We found that NOM com- plication rates for low grade injuries reached 33%, while for high grade injuries this rose to 50%. Conclusion: The principles for the management of pancreatic trauma have not been clearly delineated. Existing reports are retrospective and single centre with a limited number of patients. Prospective, mul- ticentre trials are warranted to ascertain strict crite- ria and evaluate the current recommendations. Keywords Pancreatic injury, Management of pancreatic trauma, Intraop- erative pangreatography, Surgical techniques Introduction The aim of this systematic review is to address the following three topics: i) the role of intraoperative imaging in the diagnosis and treatment of pancre- atic injuries, ii) the current management practice of pancreatic trauma in relation to the grade of the injury, iii) the complications of both the surgical and non-surgical approach. The pancreas is the fourth most commonly in- jured organ and accounts for 5% of patients with blunt abdominal trauma, 6% of patients with gun- shot wounds to the abdomen and 2% of stab wounds to the abdomen [1, 2]. Approximately 90% of pan- creatic trauma is also associated with other intra- abdominal injuries [3, 4]. Most commonly, blunt injury to the pancreas results from a direct blow to the mid-abdomen which compresses the pancreas against the vertebra, as typically occurs in traffic ac- cidents where an unrestrained individual is thrust against the steering wheel of a car or the handle The Current Management of Pancreatic Trauma M.I. Korontzi, Ch. Kontovounisios, Ch. C. Karaliotas, S. Lanitis, G.Sgourakis, T. Papakostantinou, C.Karaliotas Received 29/06/2010 Accepted 23/08/2010 A Systematic Review 358