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



Imaging Studies

suspected biliary lesion

intraoperative cholangiogram

hemodynamically stable

initial CT scan

suspected pancreatitis

repeat CT scan

after 48 hours in selected patients



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