Pancreatic trauma injury grading

Last revised by Subash Adhikari on 13 May 2022

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

Classifications

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 I: hematoma with minor contusion or superficial laceration without duct injury
  • grade II: major contusion or laceration without duct injury
  • grade III: distal transection or deep parenchymal injury with duct injury
  • grade IV: proximal transection or deep parenchymal injury involving the ampulla (and/or intrapancreatic common bile duct)
  • grade V: massive disruption of the pancreatic head ("shattered pancreas")

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

Grades I and II do not involve the duct and are considered low-grade injuries. Grades III, IV and V 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

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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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