Trauma to the Pancreas

Pancreatic trauma is most often due to impact of the seat belt or steering wheel in automobile accidents. It generally occurs as one of multiple injuries, and therefore, rarely observed isolated. Thus, clinical signs and severity are variable, depending not only on the injury to the pancreas itself but also on the extent of other injuries. The diagnosis is reached by integrating the findings of procedures such as physical examination, chest X-rays, blood tests, abdominal ultrasound, abdominal computerized tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP). The presence of other injuries can necessitate a laparotomy, and therefore, the extent of pancreatic injury must very often be determined during the operation. Treatment involves conservative observation to follow the state of pancreatic edema. The treatment of pancreatic contusion may also be conservative if the pancreatic ducts are not overtly injured. Drainage would be the basic approach if the pancreatic branch ducts are clearly injured or a crush injury is apparent. If the main pancreatic duct is ruptured in the body or tail region, the pancreatic tail is resected. In the pancreatic head region, a highly invasive pancreaticoduodenectomy should be avoided in favor of drainage designed to accommodate the possibility of a second-stage operation.（Kimura W, Watanabe T, Yano M, and Fuse A in Geka (Nankodo.Co) 67: 1063-1068, 2005