Ligated splenic artery and vein post pancreatectomy for traumatic pancreatic transection
Abdominal pain and low Hb day 2 post trauma.
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Non contrast, arterial and portal venous phases.
Multiple surgical clips in the region of the pancreas in keeping with a subtotal pancreatectomy. There is no enhancement of the spleen however there is normal enhancement within a small inferior splenunculus. No opacification of the splenic artery nor the splenic vein. These may have been clipped. There is a small amount of retrograde filling of the splenic artery at the splenic hilum. Significant free fluid within the surgical site is of fluid density (10 HU). Left abdominal drain in the lesser sac with the tip positioned just inferior to the stomach.
Liver laceration extending from the gallbladder fossa is unchanged and there is no perihepatic fluid. Possible left upper pole renal laceration is not identified. No free intraperitoneal gas. The large bowel loops of the small bowel demonstrate interval dilatation, concerning for the development of post-operative ileus.
Moderate left pleural effusion with adjacent consolidation. A small right pleural effusion. No lumbar spine or pelvic fracture.
Non-enhancement of the entire spleen and no opacification of the splenic artery or vein. Given the extensive amount of peripancreatic fluid and recent subtotal pancreatectomy, the splenic infarct and vascular non-opacification may be iatrogenic or secondary to proteolytic injury from the initial pancreatic transection. Correlation with surgical findings and subsequent intervention recommended.
Evolving post-operative ileus.
Operative notes from 2 days prior:
Subtotal pancreatectomy for trauma. Splenic artery pseudo-aneurysm. The splenic artery and vein were sacrificed (ligated), relying on the short gastric vessels to supply and drain the spleen.