Because of its protected retroperitoneal position, pancreatic injury occurs with deep penetrating wound or blunt trauma of significant force. Injury to the pancreas must be considered, however, in all patients who sustain injury to the upper abdomen. The diagnostic approach varies with the mechanism of injury. With penetrating trauma, almost all patients are operated on and the diagnosis of pancreatic injury is made at the time of exploration. The diagnosis of blunt injury requires a high degree of clinical suspicion, since there may be few symptoms during the initial phase of management. In the first several days the majority of patients will eventually will develop epigastric and/or back pain, nausea, vomiting, ileus, and tenderness to the abdominal palpitation.