Pancreatic trauma

Pancreatic trauma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Contributors: Cafer Zorkun M.D., PhD.

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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.
• 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.

Images courtesy of RadsWiki

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  Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident

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  Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident

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  Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident

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  Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident

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  Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident

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  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.

External Links

• Goldminer: Pancreatic trauma