The pancreas is located in the upper abdomen behind the peritoneum, across the spine, in a deeper position, with little movement and covered by other organs in all directions, the incidence of trauma is low, accounting for about 2% to 5% of closed abdominal injuries, but with the increase in modern traffic accidents, pancreatic injuries are also on the rise. Pancreatic injury is often combined with other organ injuries, clinical symptoms are often masked, the condition is complex, easy to cause missed diagnosis, delayed treatment, while its high incidence of complications, resulting in a high mortality rate of pancreatic injury about 12% to 20%, if delayed treatment can be as high as 60%. Therefore, early diagnosis and treatment are needed to reduce complications and mortality after injury. Type I: small hematoma, superficial laceration, no large pancreatic duct injury; Type II: larger hematoma, deeper laceration, no large pancreatic duct injury; Type III: distal pancreatic fracture with large pancreatic duct injury; Type IV: proximal pancreatic fracture or involvement of the jugular abdomen with large pancreatic duct injury; Type V: severe destruction of the head of the pancreas with large pancreatic duct injury. The diagnosis of pancreatic injury The pancreas is located in the retroperitoneum, and the anatomical site is deep and hidden. In simple pancreatic injury, a small amount of bleeding and pancreatic leakage is limited to the retroperitoneal space, and there are no obvious signs of intra-abdominal bleeding and peritoneal irritation; if the injury is combined with other organs, it is often masked by the symptoms and signs of other organs, resulting in a low preoperative diagnosis rate and delayed treatment. History and physical symptoms Paying enough attention to pancreatic injury can reduce missed and delayed diagnosis. First of all, we should take a detailed medical history and carefully examine the body to determine the site of injury, and we should be especially alert for upper abdominal impact injuries. As the disease progresses, pancreatic enzyme activation stimulates the peritoneum, causing a large amount of plasma to leak into the abdominal cavity, resulting in progressive increase in peritoneal irritation and abdominal distension, and progressive systemic reactions such as hypovolemia. Progressive abdominal distension is a meaningful symptom of pancreatic injury and should be given sufficient attention. Serum amylase measurement Serum amylase test should be done routinely in patients with upper abdominal trauma to facilitate the initial determination of pancreatic injury. If the serum amylase is significantly elevated after abdominal trauma, or if it tends to increase progressively in successive repeated measurements, it can be used as an important basis for pancreatic injury. However, the diagnosis of pancreatic injury cannot be made entirely on the basis of elevated amylase, and the diagnosis of pancreatic injury cannot be excluded on the basis of normal amylase, which needs to be combined with other imaging examinations for comprehensive judgment. If there are obvious signs and symptoms of pancreatic injury and elevated serum amylase, the diagnosis of pancreatic injury can be established; if the abdominal symptoms are not obvious and there is only elevated serum amylase, the diagnosis of pancreatic injury cannot be confirmed. Diagnostic laparotomy and puncture fluid amylase test Simple pancreatic injury laparotomy fluid is usually pink bloody fluid, not whole blood, and amylase can be elevated. If the tail of the pancreas is mildly injured, the amylase value may not be elevated if there is no obstruction or rupture of the proximal pancreatic duct and mild contusions in other areas. At the same time, the amylase measurement of laparotomy fluid is susceptible to interference from the peri-pancreatic inflammatory response and affects its results. Therefore, dynamic observation of amylase changes is more valuable to confirm the diagnosis of pancreatic injury. Ultrasonography Ultrasonography is simple and easy to perform and can be repeated. In pancreatic injury, its sonogram is uneven pancreatic echogenicity and peripancreatic fluid, but it is easily interfered by gas in the stomach and intestines and affects the diagnosis. In recent years, due to the application of endoscopic ultrasound, which is not disturbed by gas in the stomach and intestines, it has greater value in the diagnosis of pancreatic injury. CT and MRCP examination CT is the best examination method to show the retroperitoneal organs and is the most valuable examination method to determine pancreatic injury, which is non-invasive and rapid and shows the pancreatic parenchyma better than B ultrasound, and can be used to monitor the complications after pancreatic injury and postoperative patients. CT of pancreatic injury shows uneven or broken pancreatic parenchyma, hematoma, intra-abdominal or retroperitoneal fluid accumulation, fluid separation between splenic vein and pancreatic body, thickening of left anterior renal fascia, retroperitoneal hematoma, etc. However, CT has little diagnostic value in determining main pancreatic duct injury, while magnetic resonance cholangiopancreatography (MRCP) is the same as CT in diagnosing pancreatic injury and is a non-invasive, sensitive and specific method in detecting main pancreatic duct injury. MRCP examination of patients suspected of having pancreatic injury can clearly show the pancreatic duct, which is helpful in determining the injury of the pancreatic duct and the degree of injury, and can also avoid a series of complications caused by endoscopic retrograde cholangiopancreatography (ERCP). ERCP examination ERCP can be used not only for the diagnosis of pancreatic duct injury, but also for treatment, and for patients with stable hemodynamics, emergency ERCP examination is feasible. the accuracy and specificity of ERCP diagnosis of pancreatic duct injury is up to 100% for patients with partial rupture of the pancreatic duct, and minimally invasive treatment, such as the placement of a stent tube in the pancreatic duct, can also be performed. However, because most patients are admitted to the hospital in serious condition, ERCP examination and treatment are not allowed, so it is less used at present. Laparoscopy Although the number of reports of laparoscopic diagnosis of abdominal injuries has increased year by year in recent years, its application is limited due to the anatomical location of the pancreas and the presence of combined injuries in patients, and it is generally not considered in patients with severe conditions. Dissection The history and physical examination are the basis for the diagnosis of pancreatic injury, and dissection is still the most reliable method to diagnose pancreatic injury. In principle, patients suspected of having pancreatic injury should undergo dissection, and life-threatening injuries should be dealt with first during the investigation. During surgery, the intra-abdominal organs should be carefully, systematically and orderly explored, and the possibility of pancreatic injury should be highly suspected for retroperitoneal hematoma, pneumoperitoneum, saponified spots, and bile staining around the duodenum, and the gastrocolic ligament should be cut into the small omental sac, and the whole pancreas should be carefully explored comprehensively, noting whether there are lacerations, bleeding spots, and hematomas in the pancreatic envelope. If necessary, the lateral peritoneum of the duodenum should be opened and the head of the pancreas should be explored. It is difficult to confirm the diagnosis of main pancreatic duct injury before surgery, and it is easy to miss the diagnosis during the surgical exploration. The main pancreatic duct should be fully free of the pancreas and observed from both the front and back sides, if white fluid is seen, the main pancreatic duct is definitely damaged, and this phenomenon is more obvious the closer to the head of the pancreas. For those suspected of having main pancreatic duct injury, pancreatic ductography or methylene chloride injection is feasible to further confirm the diagnosis.