ISOLATED PANCREATIC HEAD INJURY SECONDARY TO BLUNT ABDOMINAL TRAUMA: A CASE REPORT
HM Babaran, M.D., MAD Lontok, M.D. St. Luke’s Medical Center Global City, Taguig City
Significance: Pancreatic injury from blunt abdominal trauma is rare (0.2-2%) among all trauma cases. Although rare, isolated pancreatic injury is associated with significant morbidity and mortality primarily due to delay in diagnosis and incorrect classification of the injury further delaying proper management. Early recognition of a disrupted Main Pancreatic Duct (MPD) is the principal cause of prevention of delayed complications, like fistula, abscess, sepsis, hemorrhage. Blunt pancreatic injuries without ductal injuries are usually managed conservatively, while surgery is the preferred otherwise.
Clinical Presentation: We present a case of a 23 year old male with persistent epigastric pain after a blunt abdominal trauma from a soccer game. Physical examination showed patient stable in pain. Abdomen was flat, no hematoma noted, bowel sounds were normoactive, soft, direct epigastric tenderness.
Management: Amylase and lipase were elevated, while CBC showed hemoconcentration and leukocytosis. Whole abdomen CT scan showed an enlarged ill-defined,fragmented-appearing pancreatic head and uncinate process which pancreatic fracture is considered with surrounding hyperdense fluid collection suggestive of hematoma in the peripancreatic and subhepatic regions, extending down to the right paracolic gutter and pelvic region. The pancreatic duct was not visualized. Subsequent MRCP showed visualized intact MPD. Management was conservative with bowel rest and pain relief. Patient showed further improvement and was discharged after a week. Repeat CT scan showed further improvement.
Recommendation: Early recognition of MPD injury may prevent delay in diagnosis and management of pancreatic injury. Early detection of an intact MPD is managed conservatively, which rarely causes morbidity or death.
Keywords: Case report, isolated pancreatic injury, blunt trauma, management