The Western Society for Emergency Surgery (WSES) published guidance for the management of 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 laparotomy:
(1) hemodynamic instability (WSES Grade IV)
(2) peritonitis
(3) evisceration
(4) impalement
(5) WSES III pancreatic injury if nonoperative management inappropriate
(6) WSES II pancreatic injury to distal pancreas (distal pancreatectomy)
(7) WSES II or III duodenal injury
(8) WSES I duodenal injury if obstruction not resolved within 14 days
(9) laceration, perforation and/or avulsion of the gallbladder
(10) WSES III extrahepatic biliary tract trauma failing endoscopic or percutaneous intervention
Nonoperative management can handle many types of injury but should only be attempted at a center with appropriate expertise and resources.
