Octreotide acetate (Sandostatin) has been reported to decrease pancreatic related morbidity after pancreatic resections. This study examined the use of octreotide after pancreatic trauma. The charts of all patients treated for pancreatic injuries from June 1988 to February 1992 were reviewed (n = 28). The mean age of the patients was 29 years (range 16 to 61). The mechanism of injury was motor vehicle accident in 7 patients, gunshot wounds in 14, and stab wounds in 7. The mean (+/- SD) abdominal trauma index (ATI) was 33 +/- 14 and injury severity score (ISS) was 22 +/- 12. Pancreatic injuries were graded as grade I (contusion) in 6 patients, grade II (parenchymal injury) in 18, and grade III (ductal injury) in 4. Seven patients (6 grade II and 1 grade III) were treated with prophylactic octreotide acetate, 150 micrograms to 300 micrograms per day, beginning on day 1. There were no pancreatic complications in this group. Of the remaining 21 patients, 6 (29%) developed 9 pancreatic complications: fluid collections in 3, fistula in 4, pseudocyst in 1, and pancreatitis in 1. Three patients had grade III, 1 had grade II, and 2 had grade I injuries. There were no differences in ATI, ISS, or grade of pancreatic injury between patients who were treated with octreotide and those who were not. No complications were associated with the use of octreotide. In conclusion, pancreatic complications occurred frequently (21%) following pancreatic trauma and resulted in significant morbidity. In this nonrandomized series of patients with equivalent ATI, ISS, and pancreatic grade injuries, the prophylactic use of octreotide was associated with no pancreatic complications and no negative sequelae.