Presentation
Blunt abdominal trauma due to a fall from a height about two weeks ago. Severe abdominal pain, vomiting, and abdominal distension for the last few days.
Patient Data
Free fluid in the perihepatic, hepatorenal, splenorenal, paracolic regions, and pelvis. An anechoic full-thickness fluid cleft in the pancreatic body sparing some parenchymal tissue on the cranial side. The defect is left to the superior mesenteric vein-portal vein axis. The rest of the pancreas shows a normal echopattern. Normal liver, spleen, and kidneys.
No free gas under the domes of the diaphragms. Increased ground glass density. Few small bowel air-fluid levels.
Case Discussion
The case shows a full-thickness injury involving the distal pancreas. The pancreatic duct is injured which may be the cause of large-volume ascites. Paracentesis is required to check the levels of amylase and protein to rule in/rule out the pancreatic origin of the ascites due to a ruptured pancreatic duct. A CT scan is needed as an isolated pancreatic injury is uncommon.