Gallbladder and Pancreas

This is a unique question-and-answer chapter for surgical residents and trainees, concentrating on the injuries of gallbladder and pancreas. A minority of bile duct injuries are recognized during the index cholecystectomy, only about 25% in most series. There are several factors that facilitate recognition of intraoperative injury, but the most important is a change in the surgeon's awareness to suspect and/or evaluate a bile duct injury. The primary non-operative diagnostic modality for pancreatic injury is CT scanning. CT scan evidence of pancreatic transection or extensive peri-pancreatic fluid warrants laparotomy. These findings are associated with a higher risk of pancreatic ductal disruption, which is the major determinant of prognosis. Necrotizing pancreatitis develops in about 15% of patients with pancreatitis and accounts for mortality ranging from 12 to 35%. The traditional approach to the treatment of necrotizing pancreatitis with secondary infection of necrotic tissue is open necrosectomy to completely remove the infected necrotic tissue.