Fact-sheet: Pancreatic trauma - fracture
Updated on 04/24/2020 at 9:35 AM
View all RADEOS cases associated with this fact-sheet
Definition
3% of blunt abdominal trauma cases are associated with post-traumatic pancreatic injury
Mechanism: direct impact against the vertebral column
Contusional injuries predominate at the body-tail junction and include simple pancreatic contusion, hematoma of the pancreatic bed, and pancreatic fracture
Laboratory findings
Hyperamylasemia
If acute pancreatitis: associated hyperlipasemia
Radiography
Plain abdominal radiograph: no value
Ultrasound
Bulky, heterogeneous appearance of the pancreatic gland with infiltration of the peripancreatic fat.
Parenchymal fractures are rarely visible.
CT
Simple contusions:
- Swollen-appearing pancreas, mildly hypodense, with modest enhancement after contrast injection
- Spontaneously dense hemorrhagic infiltration, d=60 HU
- No glandular fracture detected
Hematoma of the pancreatic bed:
- Peripancreatic collection often located in the cephalic region
- Possible contrast extravasation in cases of vascular injury
- Contiguous infiltration of the perirenal spaces
- No glandular fracture detected
Pancreatic fracture:
- Alteration of the glandular contours
- Marked heterogeneity of the pancreatic parenchyma
- Disruption of the gland and main pancreatic duct with lack of enhancement after contrast injection at the body-tail junction, corresponding to the fracture line
- Peripancreatic and perirenal fascial infiltration, often extensive
Classification
AAST
Grade 1: Minor hematoma or superficial laceration without ductal injury
Grade 2: Major hematoma or laceration without ductal injury or tissue loss
Grade 3: Distal transection or parenchymal injury with ductal involvement
Grade 4: Proximal transection or parenchymal injury involving the ampulla of Vater
Grade 5: Massive disruption of the pancreatic head
Differential diagnosis
When major trauma results in extensive infiltration, the differential diagnosis shifts to regional injuries: hepatic, renal, and especially duodenal trauma.
