Total transection of pancreatic head by blunt abdominal trauma

Abstract

Abstract

Introduction: Isolated pancreatic blunt trauma are rare and very difficult to be identified, occurring  0.2-6 %  in all the cases of an abdominal blunt trauma. The key to optimal treatment is related to the total integrity of Wirsung duct.

Objective: The goal of this study is to accurately report the clinical management of the pancreatic trauma with Wirsung duct transection.

Material and methods: Introduction of a patient with blunt abdominal trauma, having a total transection of pancreatic head, no evident duodenal injuries.

Results: A 41 years old man, that was  victim of an aggression with multiple punches  and kicks in the abdominal area and lower extremities. Clinical inspection reveals ecchymosis on the epigastric area. The patient arrived at the hospital 4 hours after the aggression. He complained strong abdominal pain. The clinical findings reveals hemodynamic stability of the patient, high abdominal sensation, normal laboratory levels of lipase and amylase enzymes. CT scan detects transection of the pancreatic head (Class III Lucas), perihepatical free fluid and on omental bursa. Surgery has been performed 6 hours after trauma.Surgical findings consisted in total transaction  of pancreatic head, Wirsung duct rupture and preserved integrity of duodenum and other abdominal organs. Surgical procedure consisted in Roux-Y pancreaticojejunostomy, ligature of the distal part of the Wirsung duct of the head, proper hemostasis of the pancreatic head, peritoneal lavage and drainage. Postoperatory prognosis was encouraging and no complications occurred. 10 days after surgery the patient is fully recovered and he was discharged.

Conclusion: The  radiological modalities have a  essential role in the evaluation of the injuries in a pancreatic trauma. Operative management is requested in severe injuries of pancreatic glandule. The prognosis of pancreatic trauma is related  mainly of the injuries of pancreatic duct.