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Blunt pancreatic trauma: A persistent diagnostic conundrum?
Journal article   Open access

Blunt pancreatic trauma: A persistent diagnostic conundrum?

Atin Kumar, Ananya Panda and Shivanand Gamanagatti
World journal of radiology, Vol.8(2), pp.159-173
02/28/2016
DOI: 10.4329/wjr.v8.i2.159
PMCID: PMC4770178
PMID: 26981225
url
https://doi.org/10.4329/wjr.v8.i2.159View
Published (Version of record) Open Access

Abstract

Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography (CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging (MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful nonoperative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma.
 Life Sciences & Biomedicine Radiology, Nuclear Medicine & Medical Imaging Science & Technology

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