Experiences in the management of XXXX .

@entity1 @entity788 @entity548 @entity660 @entity292 @entity733 @entity3210 @entity1576 @entity130
A 30-year experience in the management of 283 consecutive @entity1 with acute @entity788 was reviewed. Of these injuries 224 were penetrating; 59 were from blunt @entity130 . Diagnosis was made by laparotomy in all @entity1 , although elevated serum amylase suggested this injury in 23 (56%) of 41 @entity1 with nonpenetrating injuries. Operative measures were initially involved with correction of associated injury when present (961 organ injuries in 278 @entity1 : 3.5 injuries per @entity1 ). During the earlier years, Penrose drains were placed to the site of injury. Significant @entity660 ( @entity292 in 13, @entity788 or @entity733 in six, pseudocyst in three) were noted in 19 (46%) of the 41 @entity1 so managed. Routine sump drainage dramatically reduced the incidence of @entity660 to 2% in the 198 @entity1 having external drainage alone. Distal resection was performed in 29 @entity1 , without later @entity3210 . Most disappointing were the results from Roux-en-Y internal drainage: @entity292 developed in five and lethal bacterial @entity788 in three of the seven @entity1 so treated. Five @entity1 died from exsanguination during exploration for major vascular @entity130 , and all three @entity1 undergoing pancreaticoduodenectomy succumbed within 20 hours after operation. The overall mortality was 13.8%, with only seven deaths out of the last 100 @entity1 treated. Profound @entity548 and its complications (19), @entity788 (eight), and post-traumatic @entity1576 (three) accounted for 30 of the 39 fatalities.
