[Pancreatic trauma : Review of the diagnostic and therapeutic challenges]

Pancreatic trauma represents a rare but clinically relevant entity within abdominal trauma. It predominantly occurs in association with severe abdominal injuries and is diagnostically demanding due to the retroperitoneal position of the organ and the frequently unspecific clinical manifestations. The diagnosis is often delayed as initially only unspecific clinical signs are mostly present. Contrast-enhanced computed tomography is currently considered the gold standard in the initial diagnostics, whereby the sensitivity with respect to pancreatic injuries is limited, especially in the early phase. Magnetic resonance imaging (MRI with MR cholangiopancreatography, MRCP) and endoscopic retrograde CP provide valuable supplementary information for assessment of ductal involvement. The treatment approach depends on the severity of the injury according to the American Association for the Surgery of Trauma (AAST) classification, the integrity of the pancreatic duct and the presence of accompanying intra-abdominal injuries. Low-grade pancreatic lesions can frequently be treated conservatively but high-grade traumatic injuries and duct involvement usually require surgical or interventional measures. Despite progress in the diagnostics and treatment, pancreatic trauma is still associated with a high morbidity. An early diagnosis and an interdisciplinary management in specialized centers are decisive for the prognosis.