The Western Society for Emergency Surgery (WSES) reported a diagnostic approach for a patient with traumatic injuries to the duodenum, pancreas and extra-hepatic biliary tract.
Patient selection: blunt or penetrating trauma to the duodenum, pancreas and/or extrahepatic biliary tract
Indications for operative exploration:
(1) hemodynamic instability
(2) free air in peritoneum or retroperitoneum
(3) localized bowel wall thickening
(4) evisceration
(5) impalement
(6) peritonitis
Suspected pancreatitis: serial serum amylase and serum lipase every 6 hours
Situation
Imaging Studies
suspected biliary lesion
intraoperative cholangiogram
hemodynamically stable
initial CT scan
suspected pancreatitis
repeat CT scan
after 48 hours in selected patients
ERCP or MRCP
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