CT of blunt trauma of the pancreas in adults

In order to describe the CT findings in pancreatic injury and to evaluate the sensitivity of this technique, we performed a retrospective study. During a 5-year period (1993-1997), eight patients (five males and three females: age range 10-47 years) were investigated with CT. Endoscopicretrograde cholangiopancreatography (ERCP) was obtained in two patients, pre- and intra-operatively, respectively. Among the standard laboratory tests obtained at admission, the value of serum amylase was reviewed. The imaging findings, especially those obtained with CT, were correlated with the surgical findings, when available (in seven of eight patients). At admission, diagnosis of pancreatic injury was missed at CT in three of eight patients (37.5%); thus, the sensitivity of CT for pancreatic injury was 62.5%. ERCP showed rupture of the pancreatic duct in the two cases in which it was performed. Serum amylase was elevated at admission in four of eight patients, resulting in a sensitivity of 50%. After surgery, an enterocutaneous fistula developed in one case, and was managed conservatively. One patient died from brain injury. Proper implementation of the CT technique and accurate film reading is mandatory to establish the diagnosis of pancreatic contusion. No correlation between CT features and type of outcome of surgical management could be established. On retrospective review of the CT examinations, it appeared that two of the three false-negative results could have been avoided. Therefore, proper CT technique and accurate film reading are mandatory in establishing the diagnosis of pancreatic injury.