Isolated pancreatic laceration in a pediatric patient with closed abdominal trauma

Case contributed by Raul Emilio Vleeschower Carvajal
Diagnosis certain


A patient with a history of blunt abdominal trauma three days prior with a bicycle handle, after an exploratory laparotomy was realized, had apparent hemoperitoneum secondary to splenic damage. Clinically with mild respiratory distress and moderate epigastric abdominal pain.

Patient Data

Age: 7 years
Gender: Female

Axial CT enhanced showing a hypodense line at the level of union between the head and neck of the pancreas, associated with the presence of free peripancreatic fluid. Normal spleen.

Volumetric reconstruction of the pancreatic parenchyma shows a lineal trace at the union of the head and neck of the pancreas.

The MRI T2 HASTE sequence confirms the location of the laceration trace at the junction of the head and the neck of the pancreas, observing linear hypointensity.

Case Discussion

A pancreatic laceration is the loss of continuity of the organic parenchyma associated or not with dissection of the main duct, which allows its classification into five grades by the American Association of Surgical Trauma (AAST):

  • I: minor laceration without duct involvement

  • II: major laceration without duct involvement

  • III: distal parenchymal involvement with partial involvement of distal duct transection

  • IV: proximal parenchymal involvement with proximal duct transection

  • V: massive head disruption with proximal duct transection

In pancreatic lesions, the contrast allows visualization of hypodensities suggestive of laceration or early hematoma. Guidance on pancreatic duct involvement in this study is difficult unless we find frank transection of the glandular structure, however, the perilesional findings allow us to orient the damage since they create a focal area of inflammation with alterations associated with the externalization of pancreatic secretion products. When in doubt, different guides recommend exploratory laparotomy since its performance is associated with a decrease in morbidity and mortality, if there’s no clinical emergency it's suggested to monitor the patient waiting to perform Magnetic resonance cholangiopancreatography for assessment of the pancreatic duct or even retrograde cholangiopancreatography.

In this case, the patient remained under clinical surveillance and surgical evaluation, which corroborated the pancreatic laceration and making a classification of grade II according to AAST, continuing expectant management with a good prognosis.

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