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Pancreatic transection - possible non-accidental injury

Case contributed by Dr Tim Luijkx


Bilious vomiting. Tender abdomen.

Patient Data

Age: 2 years
Gender: Male

Initial radiograph is unremarkable

Nonspecific bowel gas pattern. No evidence of pneumoperitoneum or bowel obstruction.


Ultrasound requested querying intussusception

No evidence of intussusception.

Large complex, septated collection or mass throughout the abdomen and around the left kidney, suggestive of hemoperitoneum.

The appearances of the liver, kidneys and spleen are normal.

Laparotomy showed haemoperitoneum and something dark purple noted in the retroperitoneum. Lipase 1368. Haemoglobin 91 dropping from 131. 


CT 2 days post-operative

Oral contrast was not administered. Difficult interpretation due to a low-dose scanning technique, widespread subcutaneous and intra-abdominal edema, as well as lack of oral contrast.


Enteric catheter tip lies within the proximal duodenum.
Widespread subcutaneous and intra-abdominal fat stranding and edema (both intraperitoneal, and retroperitoneal). Multiple locules of free gas in the anterior abdomen. Evidence of subcutaneous emphysema in the left anterior abdominal wall in keeping with recent surgery.

A 1.5 cm defect is present in the body of the pancreas having the appearance of transection. Peripancreatic edema is present anteriorly predominantly in the lesser sac with no discrete collection.

The liver, spleen, adrenal glands and kidneys appear unremarkable.

A moderate amount of free fluid amongst the small bowel loops.

There is a left-sided pleural effusion. There is minor subsegmental left lower lobe collapse. No bony lesions identified


Likely pancreatic transection (arrows), peripancreatic edema, free intraperitoneal fluid and left pleural effusion.

Case Discussion

The nature of the injury together with a history lacking a good explanation for it is concerning for non-accidental injury.

At 2 years of age, a child becomes too big to be shaken and the typical injuries associated with this (among others, metaphyseal corner fracture, rib fractures, subdural hematomas) are becoming infrequent.

Pancreatic transection and rupture of lymphatics are known to occur in the context of non-accidental injury.

Of note, a third of all post traumatic pancreatitis is abuse related.

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Case information

rID: 56579
Published: 10th Nov 2017
Last edited: 9th Nov 2020
Inclusion in quiz mode: Included

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