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[Pancreatic trauma: a case report].

Gaetano La Greca1, Giorgio Castello, Francesco Barbagallo

  • 1Divisione Clinicizzata di Chirurgia d'Urgenza, Dipartimento d'Emergenza, Trapianti e Tecnologie Avanzate, Università degli Studi di Catania, Ospedale Cannizzaro Catania.

Chirurgia Italiana
|May 30, 2006
PubMed
Summary

Severe pancreatic trauma, though rare, has high mortality due to delayed diagnosis and hemorrhage. Early recognition and surgical management preserving pancreatic parenchyma are crucial for better outcomes.

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Area of Science:

  • Trauma Surgery
  • Gastrointestinal Surgery
  • Surgical Critical Care

Background:

  • Pancreatic trauma is a rare but severe injury, comprising ~3% of blunt abdominal traumas with 5-30% mortality.
  • High mortality is primarily linked to hemorrhagic lesions and diagnostic delays, not direct pancreatic damage (5-10%).

Observation:

  • A case of severe pancreatic trauma, initially underestimated and treated surgically later, is presented.
  • Diagnostic challenges include underrecognition and delays, especially in hemodynamically unstable patients where shock management takes priority.
  • Multislice CT and MR pancreatography-wirsungography aid diagnosis in stable patients.

Findings:

  • Delayed diagnosis is a significant challenge in pancreatic trauma management.
  • Treatment strategies (conservative vs. surgical) depend on the extent of injury, particularly to the Wirsung duct.

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  • Surgical parenchyma-preserving techniques, though demanding, maintain pancreatic function and reduce metabolic complications.

    • Implications:

    • Emphasizes the need for heightened clinical suspicion and timely diagnostic workup in suspected pancreatic injuries.
    • Highlights the importance of advanced imaging modalities for accurate diagnosis in hemodynamically stable patients.
    • Advocates for parenchyma-preserving surgical approaches to optimize long-term pancreatic function and patient outcomes.