الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Injuries to the pancreaticoduodenal complex present a significant challenge both in diagnosis and management. The retroperitoneal location of the pancreas means that it is not a common site of injury, but this also contributes to the difficulty in diagnosis, as the organ is concealed, and investigation often results in delay with its attendant increase in morbidity. Pancreatic trauma is associated with a high incidence of injury to adjoining organs and major vascular structures, which adds to the high morbidity and mortality, and complications occur in 30-60% of patients. The diagnosis of pancreatic and duodenal injuries will often present a diagnostic challenge. The key to diagnosis of duodenal injuries is a high index of suspicion based on a consideration of the injury mechanism. Routine laboratory tests are not helpful in the preoperative diagnosis of duodenal rupture. Serum amylase and lipase levels have a high false-positive and false-negative rates for duodenal trauma. The diagnosis of blunt pancreatic injury should be suspected in patients with epigastric or diffuse abdominal tenderness, leukocytosis, or epigastric abdominal wall ecchymoses. Currently the concept of Damage Control Surgery has been applied to treat severe traumatic patients. DCS is the prevention of metabolic failure by application of limited or staged procedures to control hemorrhage, limit sepsis and protect from further injury. After exposure of the pancreas, the choice of repair will depend on the patient’s hemodynamic status, presence or absence of injury to the main pancreatic duct, and presence or absence of a concomitant duodenal injury. The surgical management of the duodenal injuries would depend on hemodynamic stability, severity of duodenal injury, and the presence and severity of associated pancreatic injury. Conclusion: Diagnosis of pancreatic & duodenal injuries is considered as a challenge and sure diagnosis is only after laparotomy. The indications for operative management in patients with blunt or penetrating abdominal trauma that may involve the pancreas are as follows: Peritonitis on physical examination; Hypotension and a positive ultrasound examination of the abdomen; and Evidence of disruption of the pancreatic duct on fine-cut CT or on ERCP. The main complication after repair of pancreatico-duodenal injuries is fistula & its main line of treatment is conservative