Pancreatic rupture following a bull-head caused blunt abdominal trauma

A 33-year-old man was admitted to our hospital with clinical and instrumental-diagnostic evidence (CT) of haemoperitoneum following a blunt abdominal trauma due to being butted by a bull. A full-thickness rupture of the pancreas, at the level of the isthmus, was found at laparotomy. The emergency procedure consisted in evacuation of the haemoperitoneum, haemostasis and suture of the pancreatic lesion plus drainage of the lesser sac. A high-output (800 ml/day) post-traumatic pancreatic fistula developed in the following days, with the need for a second operation. In the presence of a large pancreatic defect extensively communicating with the Wirsung duct, a singular surgical procedure was adopted in the form of a Roux-en-Y pancreaticojejunostomy with catheterisation of the pancreatic fistula using a small disposable silicone catheter. The post-operative course was uneventful and healing of the pancreatic fistula was documented at CT scan 39 days after the operation.