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.

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.

Diagnostic Findings

CT

• 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.

External Links

• Goldminer: Pancreatic trauma