Surgery

THE authors describe four instances of external pancreatic fistula occurring after operation for injury to the head or neck of the pancreas. They state that all should have been treated primarily by internal Roux-en-Y drainage of the head and neck of the pancreas. However, two of the patients were thought to have been unable to tolerate the procedure at operatton due to the severity of their condition. In the third, the pancreatic injury was undiscovered during the operation, and in the fourth the procedure was attempted but failed due to technical error. The authors point out that all patients had a very stormy and prolonged convalescence, and state that expectant management is successful in most of these post-traumatic, postoperative flatulee, but that the htgb, volume output of pancreatic secretions makes surgical closure mandatory. They consider the operation of choice to be fistulectomy and Roux-en-Y pancreatojejunostomv, which secures the jejunal limb to the pancreatic defect.