Magnetic resonance cholangiopancreatograpy (MRCP) is a non-invasive diagnostic tool which may enable the detection of pancreatic duct injury. The use of MRCP is recommended in hemodynamically stable patients [6] and

it also allows detection of specific pancreas-related complications [7]. On the other hands, the advantage of MRCP is reported that MRCP does not provide real-time visualization of ductal filling and extravasation. For this reason, MRCP does not allow for confirmation of ductal communication with a pancreatic pseudocyst or other fluid selleck chemicals collection [6]. Gougeon et al. reported a diagnostic approach to pancreatic injury by ERCP

in 1976[8]. Although it is invasive, ERCP is the most accurate diagnostic tool for ductal evaluation, and it can also be used to provide treatment. However, delays in ERCP have led to significantly higher complication rates. Early ERCP was found to be PI3K inhibitor associated with significantly fewer pancreas-related complications than later ERCP [9]. Although ERCP is the most useful procedure for the diagnosis of pancreatic ductal injury in stable patients, surgery should be considered without hesitation if the patient’s condition is unstable. Most pancreatic injuries involving hematomas and small tears without pancreatic ductal disruption are generally managed check details conservatively with observation and selective drainage. In contrast, injuries of grade III and IV, according to the pancreatic organ injury scale of the American Association for the Surgery of Trauma (AAST) (Table 1) [10], are controversial. Since many authors Y-27632 2HCl argue in favor of an early operative intervention to prevent increased morbidity caused by delay, they recommend surgery and the surgical removal of the organ when the

duct is involved [3]. There are a number of alternative procedures that can be used for the management of grade IV injury, such as duodenal diversion, pyloric exclusion, the Whipple procedure, or simple drainage, with the choice dependent on the patient’s hemodynamic status and the presence or absence of associated duodenal injury [11, 12]. Sometimes, the decision to do a pancreaticoduodenectomy is unavoidable. If patient is hemodynamically unstable, it should be performed as a two-step procedure. After the initial damage control surgery, anastomoses are completed at a second surgery when the patient is stable.