At laparotomy you find that the peritoneum over an injured patient’s pancreas is discoloured and oedematous; sometimes with yellow opaque areas of fat necrosis.
Open his lesser sac by detaching his greater omentum from his transverse colon. Reflect his stomach upwards, and his transverse colon downwards, to expose his pancreas. If his pancreas is only bruised, insert a drain and close his abdomen.
If there is a tear in the surface of his pancreas, suture it.
If the tail of his pancreas has been torn off, remove it, cut it across in a fish tail incision, find the end of the duct, and tie this with a nonabsorbable suture. Then join the two ends of the fish tail, using nonabsorbable sutures through its capsule. Drain the area.
If his pancreas is hopelessly torn, insert a drain and close his abdomen.
