Pancreatic trauma injury grading

A number of pancreatic injury grading systems have been proposed for pancreatic trauma.


American Association for the Surgery of Trauma (AAST) 5,7

The proximal pancreas is defined as the gland to the right of the superior mesenteric vein (SMV)-portal vein axis whereas the distal pancreas is to the left of the axis. The term deep refers to an injury down to the level of the duct whereas superficial implies the injury is superficial to the duct 7.

  • grade 1: hematoma with minor contusion or superficial laceration without duct injury
  • grade 2: major contusion or laceration without duct injury
  • grade 3: distal transection or deep parenchymal injury with duct injury
  • grade 4: proximal transection or deep parenchymal injury involving the ampulla (and/or intrahepatic common bile duct)
  • grade 5: massive disruption of the pancreatic head ("shattered pancreas")

N.b. advance one grade for multiple injuries up to grade 3.

Grades 1 and 2 do not involve the duct and are considered low-grade injuries. Grades 3,4 and 5 involve the duct and constitute high-grade injuries.

Wong et al. 3

A more simple method for grading severity on CT in pancreatic injury proposed by Wong et al. 3 is:

  • grade A: pancreatitis or superficial laceration only
  • grade B
    • BI: deep laceration involving pancreatic tail
    • BII: complete transection of pancreatic tail
  • grade C
    • CI: deep laceration involving pancreatic head
    • CII: complete transection of pancreatic head
Pancreatic pathology

Article information

rID: 10014
Synonyms or Alternate Spellings:
  • Pancreatic trauma grading
  • Grading of pancreatic trauma
  • Grading of pancreatic injury

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Cases and figures

  • Fig 1: grade 1
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  • Case 1: AAST grade 3
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  • Fig 2: grade 2
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  • Fig 3: grade 3
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  • Fig 4: grade 4
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  • Fig 5: grade 5
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