Table 6 Duodeno-pancreatic and extra-hepatic biliary tree lesions

Minor

WSES class I

Pancreas

I–II

- Minor contusion without duct injury

Superficial laceration without duct injury

- Major contusion without duct injury or tissue loss

Major laceration without duct injury or tissue loss

Duodenum

I

- Hematoma involving a single portion of duodenum

Laceration: partial thickness, no perforation

Extrahepatic biliary three

I–II–III

- Gallbladder contusion/hematoma. Portal triad contusion

- Partial gallbladder avulsion from liver bed; cystic duct intact. Laceration or perforation of the gallbladder

- Complete gallbladder avulsion from liver bed. Cystic duct laceration

Moderate

WSES class II

Pancreas

III

- Distal transection or parenchymal injury with duct injury

Duodenum

II

- Hematoma involving more than one portion

Laceration with disruption of less than 50% of circumference

Extrahepatic biliary three

IV

Partial or complete right hepatic duct laceration

Partial or complete left hepatic duct laceration

Partial common hepatic duct laceration (< 50%)

Partial common bile duct laceration (< 50%)

Severe

WSES class III

Pancreas

IV–V

- Proximal transection or parenchymal injury involving ampulla

- Massive disruption of pancreatic head

Duodenum

III–IV–V

- Disruption 50–75% of circumference of D2

Disruption 50–100% of circumference of D1, D3, and D4

- Disruption > 75% of circumference of D2 involving ampulla or distal common bile duct

- Massive disruption of duodeno-pancreatic complex

Devascularization of duodenum

Extrahepatic biliary three

V

> 50% transection of common hepatic duct

> 50% transection of common bile duct

Combined right and left hepatic duct injuries

Intraduodenal or intrapancreatic bile duct injuries

WSES class IV

Any

Any

Any degree of lesion with hemodynamic instability