Pancreatic transection

Case contributed by Dr Mohamed Saber

Presentation

The patient was injured in a motor vehicle accident with direct abdominal trauma.

Patient Data

Age: 20 years
Gender: Male

A hypodense line has seen transecting pancreatic head/neck junction with an adjacent parenchymal contusion. Peripancreatic, pancreaticoduodenal as well as bilateral retroperitoneal hematomas larger at the left side seen surrounding and displacing the left kidney anteriorly. Associated small hepatic lacerations. No evidence of active contrast extravasation. Intraperitoneal free collection is also noted.

Arrows point to a transaction at pancreatic head/neck junction with surrounding parenchymal contusion.

Case Discussion

Pancreatic injuries are occasionally overlooked in patients subjected to abdominal trauma despite it is a serious injury with high morbidity and mortality. Moreover, pancreatic injury is rare and imaging diagnosis is usually challenging especially if the CT study is limited and has done urgently with no contrast injection. As a rule of thumb, if there is a collection in the peri-pancreatic and retroperitoneal regions, the pancreatic injury should be suspected even it is not seen directly.

This case represents an example of the usual challenging situation facing radiologists in trauma patients with multiple distracting obvious findings away from the uncommon, barely visible serious pancreatic injury. The patient's serum Lipase was 6770 U/L and serum Amylase was 965 U/L. Severe pancreatic injury involving ducts was confirmed on laparotomy. The patient transferred to a higher center for a major surgical interference.     

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