Isolated traumatic pancreatic rupture

Isolated Pancreatic Transection Secondary to Abdominal Blunt Trauma - A Case Report

“…[1] For the injury to occur, the impact must be of a high velocity resulting into compression of the pancreas to the vertebral column. [2] Pancreatic injuries occur in 1-5% of all abdominal injuries due to blunt force (IPT occurring in less than 1%), with an increased occurrence -12% in abdominal injuries due to penetrating trauma and a high grade of morbidity (30-60%) and mortality (10-30%) [1][2][3][4][5][6] Pancreatic injuries involving the neck and body are approximately 65% with approximately 35% involving the head and tail. [3] Concurrent small bowel lesions occur in approximately 90% of the patients with pancreatic injury due to anatomically proximal location with duodenal lesions being most common along with injury to vascular structures.…”

“…The diagnosis of pancreatic injury is more often done intraoperatively [1][2][3] during laparotomy primarily because it is difficult to establish preoperatively owing to non-specificity of the radiological tests, non-reliability of biochemical tests such as serum Lipase and serum Amylase and retroperitoneal location of the pancreas [2,5,9,10] . Delay in diagnosis and treatment for more than 24 hours causes an increase in the morbidity and mortality rates causing complications in at least one-third of the cases such as: 1) Pseudocysts, 2) Abscesses, 3) Haemorrhage, 4) Fistulas or 5) Sepsis with Multi-organ failure.…”

“…[1,3] Elevated serum Amylase and serum Lipase tests are inconclusive tests only used to indicate the possibility of pancreatic trauma. [1,2,7] Serum Amylase levels are raised in approximately 66%-90% of all pancreatic injuries, but at an early stage, they could be within normal limits. There is no association between pancreatic trauma grades and biochemical analysis such as serum Amylase.…”

“…For a clinically stable patient, Computed Tomography (CT) is considered to be the best tool for diagnosis of pancreatic injury. [1][2][3] Sensitivity of the test is 60-85%, being lower (43%) to demonstrate the integrity of the pancreatic duct. [1,3,4] The following are clear indications of pancreatic trauma: (1) Glandular contusion, (2) Glandular laceration, and (3) transection defined by lacerations involving 50% or more thickness of the pancreas with a risk of involving the main duct).…”

“…The indirect signs are: (1) peripancreatic fluid in lesser sac, (2) pancreatic hematoma or partial laceration, (3) diffuse enlargement of the gland with pancreatitis or focal oedema at the site of injury, and (4) thickening of the left anterior renal fascia. [1][2][3] Magnetic Resonance Cholangio-Pancreaticography (MRCP) is another method used in cases where the CT shows an imprecise picture. It is more advantageous than Endoscopic Retrograde Cholangio-Pancreaticography in terms of less invasiveness, faster technique, increased sensitivity (due to stimulation with secretin), and can determine anomalies not visible through ERCP such as collection of fluid upstream of the site of injury to the duct, and for assessment of pancreatic trauma [3,7,13] .…”