Pancreatic trauma: Difference between revisions
(→CT) |
Kiran Singh (talk | contribs) |
||
| (5 intermediate revisions by 2 users not shown) | |||
| Line 18: | Line 18: | ||
'''Contributors:''' [[User:zorkun|Cafer Zorkun]] M.D., PhD. | '''Contributors:''' [[User:zorkun|Cafer Zorkun]] M.D., PhD. | ||
==Overview== | ==Overview== | ||
| Line 37: | Line 37: | ||
===Diagnostic Findings=== | ===Diagnostic Findings=== | ||
==== | ====Computed Tomography==== | ||
*Direct signs of pancreatic injury include pancreatic laceration, transection, and comminution. <ref>Avneesh Gupta, Joshua W. Stuhlfaut, Keith W. Fleming, Brian C. Lucey, and Jorge A. Soto. [http://radiographics.rsnajnls.org/cgi/content/abstract/24/5/1381 Blunt Trauma of the Pancreas and Biliary Tract: A Multimodality Imaging Approach to Diagnosis.] RadioGraphics 2004 24: 1381-1395.</ref> | *Direct signs of pancreatic injury include pancreatic laceration, transection, and comminution. <ref>Avneesh Gupta, Joshua W. Stuhlfaut, Keith W. Fleming, Brian C. Lucey, and Jorge A. Soto. [http://radiographics.rsnajnls.org/cgi/content/abstract/24/5/1381 Blunt Trauma of the Pancreas and Biliary Tract: A Multimodality Imaging Approach to Diagnosis.] RadioGraphics 2004 24: 1381-1395.</ref> | ||
| Line 44: | Line 44: | ||
*Peripancreatic fat stranding, hemorrhage, and fluid between the splenic vein and pancreas are useful secondary signs. | *Peripancreatic fat stranding, hemorrhage, and fluid between the splenic vein and pancreas are useful secondary signs. | ||
<gallery> | [http://www.radswiki.net Images courtesy of RadsWiki] | ||
Image:Pancreatic-laceration-001.jpg|A patient with pancreatic transection and pseudocyst formation from motor vehicle accident | |||
Image:Pancreatic-laceration-002.jpg | <gallery perRow="3"> | ||
Image:Pancreatic-laceration-003.jpg | Image:Pancreatic-laceration-001.jpg|Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident | ||
Image:Pancreatic-laceration-004.jpg | Image:Pancreatic-laceration-002.jpg|Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident | ||
Image:Pancreatic-laceration-005.jpg | Image:Pancreatic-laceration-003.jpg|Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident | ||
Image:Pancreatic-laceration-006.jpg | Image:Pancreatic-laceration-004.jpg|Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident | ||
Image:Pancreatic-laceration-005.jpg|Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident | |||
Image:Pancreatic-laceration-006.jpg|Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident | |||
</gallery> | </gallery> | ||
| Line 71: | Line 73: | ||
{{Symptoms and signs}} | {{Symptoms and signs}} | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Latest revision as of 16:56, 11 June 2015
| Pancreatic trauma |
|
WikiDoc Resources for Pancreatic trauma |
|
Articles |
|---|
|
Most recent articles on Pancreatic trauma Most cited articles on Pancreatic trauma |
|
Media |
|
Powerpoint slides on Pancreatic trauma |
|
Evidence Based Medicine |
|
Cochrane Collaboration on Pancreatic trauma |
|
Clinical Trials |
|
Ongoing Trials on Pancreatic trauma at Clinical Trials.gov Trial results on Pancreatic trauma Clinical Trials on Pancreatic trauma at Google
|
|
Guidelines / Policies / Govt |
|
US National Guidelines Clearinghouse on Pancreatic trauma NICE Guidance on Pancreatic trauma
|
|
Books |
|
News |
|
Commentary |
|
Definitions |
|
Patient Resources / Community |
|
Patient resources on Pancreatic trauma Discussion groups on Pancreatic trauma Patient Handouts on Pancreatic trauma Directions to Hospitals Treating Pancreatic trauma Risk calculators and risk factors for Pancreatic trauma
|
|
Healthcare Provider Resources |
|
Causes & Risk Factors for Pancreatic trauma |
|
Continuing Medical Education (CME) |
|
International |
|
|
|
Business |
|
Experimental / Informatics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Contributors: Cafer Zorkun M.D., PhD.
Overview
- In the acute setting, pancreatic injuries may result in death due to associated vascular injuries.
- Delayed morbidity and mortality are usually caused by complications resulting from disruption of the pancreatic duct.
- Duct injury may lead to complications such as abscess, pancreatic pseudocyst, fistula, and pancreatitis.
- The pancreas is vulnerable to crushing injury in blunt trauma due to impact against the adjacent vertebral column.
- Two-thirds of pancreatic injuries occur in the pancreatic body, and the remainder occur equally in the head, neck, and tail.
- Isolated pancreatic injuries are rare, and associated injuries, especially to the liver, stomach, duodenum, and spleen, occur in over 90% of cases.
- In adults, over 75% of blunt injuries to the pancreas are due to motor vehicle collisions.
- In children, bicycle injuries are common, and child abuse may result in pancreatic injuries in infants.
Diagnosis
- Pancreatic injuries may be difficult to diagnose clinically.
Diagnostic Findings
Computed Tomography
- Direct signs of pancreatic injury include pancreatic laceration, transection, and comminution. [1]
- Fluid collections, such as hematomas, pseudocysts, and abscesses, are often seen communicating with the pancreas at the site of fracture or transection.
- Focal enlargement of the pancreas and peripancreatic fluid are suggestive of pancreatic injury.
- Peripancreatic fat stranding, hemorrhage, and fluid between the splenic vein and pancreas are useful secondary signs.
-
Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
-
Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
-
Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
-
Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
-
Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
-
Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
Treatment
Disruption of the pancreatic duct is treated surgically or by therapeutic endoscopy with stent placement, while injuries without duct involvement are usually treated nonsurgically.
Prognosis
- Although uncommon, early diagnosis is crucial, since delayed complications such as fistula, abscess, sepsis, and hemorrhage may lead to significant mortality, occurring in up to 20% of cases.
- Death due to delayed complications is usually due to sepsis and multiorgan failure.
- The main source of delayed morbidity and mortality from pancreatic trauma is disruption of the pancreatic duct. Injuries that spare the pancreatic duct rarely result in morbidity or death.
References
- ↑ Avneesh Gupta, Joshua W. Stuhlfaut, Keith W. Fleming, Brian C. Lucey, and Jorge A. Soto. Blunt Trauma of the Pancreas and Biliary Tract: A Multimodality Imaging Approach to Diagnosis. RadioGraphics 2004 24: 1381-1395.
External Links
Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs