Blunt pancreatoduodenal injury has historically challenged surgeons because of the difficulty of establishing a correct early diagnosis and the fear that a missed injury will lead to increased morbidity and mortality. The fact that severe BPI is rare makes it difficult to establish evidenced-based algorithms, since no single institution is likely to have an extensive experience with the management of such injuries. Indeed, many of the current treatment recommendations such as drainage for minor injuries, ERCP to establish ductal integrity, and distal pancreatectomy for more severe injuries have seldom been tested against other management strategies.
Sutton JE. Blunt Pancreatoduodenal Injury—Invited Critique. Arch Surg. 2009;144(5):419-420. doi:10.1001/archsurg.2009.58