Duodeno-Pancreatic and Extrahepatic Biliary Trauma

Duodeno-pancreatic and extra-hepatic biliary trauma are rare traumatic lesions that often occur in the context of major multi-organ lesions and can require multidisciplinary management. Endoscopists, radiologists, and gastronterologists are essential in the early diagnosis and management, in nonoperative management (NOM), and in the treatment of complications. Mortality increase enormously with time in these traumas, and the management should be as early and quick as possible. The American Association for the Surgery of Trauma (AAST) has proposed a grading system for duodenal, pancreatic, and extrahepatic biliary tree injuries indicating degree and description of the lesions. Recently, the World Society of Emergency Surgery (WSES) revised the guidelines and proposed a classification in four classes considering both the AAST classification and the hemodynamic status. Penetrating trauma or hemodynamic instability often require surgical exploration, and in this context control of bleeding is crucial. E-FAST may suggest the presence of a perforation, but, in a hemodynamically stable patient, CT-Scan remains the gold-standard exam to evidence the degree of the lesion. In minor traumas, stable patients, and isolated injuries, NOM may be considered, but, when multiple organs are involved or in severe injuries, surgical management becomes unavoidable.