Blunt Trauma of the Pancreas and Biliary Tract: A Multimodality Imaging Approach to Diagnosis

Abstract

Injuries of the pancreas, gallbladder, and bile ducts due to blunt trauma are relatively uncommon and difficult to detect but are associated with high morbidity and mortality, especially if diagnosis is delayed. Accurate and early diagnosis is imperative, and imaging plays a key role in detection. Knowledge of the mechanisms of injury, the types of injuries, and the roles of various imaging modalities is essential for prompt and accurate diagnosis. Early recognition of disruption of the main pancreatic duct is important because such disruption is the principal cause of delayed complications. Computed tomography (CT) can demonstrate pancreatic parenchymal injuries and complications such as abscess, fistula, pancreatitis, and pseudocyst. CT findings can also suggest disruption of the pancreatic duct; however, the ability of CT to indicate this finding depends on the degree of parenchymal injury. Magnetic resonance (MR) cholangiopancreatography allows direct imaging of the pancreatic duct and sites of disruption. Gallbladder injuries can be detected with CT, ultrasonography, hepatobiliary scintigraphy, or MR cholangiopancreatography. CT findings include a collapsed gallbladder, wall thickening, inhomogeneous mural enhancement, and pericholecystic fluid. Bile duct injuries can be suggested with CT, which may show ascites and associated liver injuries, and can be confirmed with hepatobiliary scintigraphy.

Diagnosis of Gallbladder Perforation—a Puzzle!

“…It demonstrates the exact site of bile duct disruption and may allow stent placement in selected bile duct injuries. ERCP images show disruption of the bile duct wall and extravasation of contrast material [9].…”

Prospective study of management and outcome of blunt abdominal trauma (solid organs and hollow viscus injuries)

“…The commonest complications were found infection and chest infection. 16 In present study, the complication rate was 32%. The commonest complication was Wound Infection followed by Respiratory complication and biliary fistula formation.…”

Pancreatic Laceration in a Female Collegiate Soccer Athlete: A Case Report

“…It is suggested that the CT examination be performed with both intravenous and oral contrast. 17 This method was used for our patient, and even though the mesenteric infiltration and fluid suggested visceral trauma, the CT scan was inconclusive for pancreatic injury. Although CT scan may potentially identify a pancreatic laceration, it does not give information about the pancreatic duct.…”