Pancreatic trauma presents challenging diagnostic and therapeutic dilemmas to trauma surgeons. Injuries to the pancreas have been associated with reported morbidity rates approaching 45%. If treatment is delayed, these rates may increase to 60%. The integrity of the main pancreatic duct is the most important determinant of outcome after injury to the pancreas. Undiagnosed ductal disruptions produce secondary infections, fistulas, fluid collections, and prolonged stays in the intensive care unit and hospital. This article analyzes the epidemiology, diagnostic approaches, options for nonoperative and operative management, and outcome after blunt and penetrating pancreatic trauma.