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[Blunt isolated pancreatic trauma. Diagnostic problems--a clinical and radiological challenge]
Hans-Erik Wittendorff1, Eva M Fallentin, Mark Berner Hansen
1Kirurgisk gastroenterologisk afdeling, Amtssygehuset i Herlev. Wittendorff@dadlnet.dk
Introduction:
Blunt isolated pancreas trauma is rare, but it is a very serious condition. Diagnosis and treatment are often delayed, which considerably increases morbidity. The delay is caused by uncharacteristic symptomatology and the application of paraclinical and radiological diagnostic methods of low initial sensitivity and specificity. The aim of this study was to describe the diagnostic difficulties and the applicability of the various radiological modalities.
Material And Methods:
During the period 1995-2000, three patients with blunt isolated pancreas trauma were treated, and the case reports were examined retrospectively.
Results:
All three showed classical mechanisms of injury, and a characteristic delay in diagnosis and treatment of 24 to 48 hours was seen.
Discussion:
The frequent delay in diagnosis and subsequent treatment of the blunt pancreas trauma requires a more optimal strategy for handling such traumas. We recommend the following diagnostic algorithm: Repeated measurements of serum amylase initially. Image diagnostics with a dynamic spiral CT-scan with both oral and intravenous contrast. The CT scan is to be repeated or supplemented by MRCP on continued suspicion of pancreas injury, even when the initial CT scan shows normal findings.