Pancreatic trauma

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.

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.

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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.