Introduction Pancreatic trauma has long been a neglected realm in abdominal injury, largely because the pancreas has been considered to be a friable, relatively inaccessible, and highly hazardous structure with which to work. Nevertheless, as trauma assumes an increasingly important role in surgery, some valuable therapeutic principles have emerged. Few reports of substantial series of nonoperative pancreatic injury have appeared until recently. With high-speed travel and the resultant injuries continually increasing, greater emphasis is being placed on salvage of patients with severe and, frequently, multiple injuries. The pancreas occupies an unfortunate position, for the patient and the surgeon, being centrally placed and overlying the relatively rigid aorta and vertebral column. A force striking the abdomen anteriorly may directly tear or fracture the gland, or a contrecoup injury may result. Injury is more likely to occur if the force strikes the relaxed abdomen, or if the patient is unconscious. Penetrating wounds