Learning objectives
Role of CT in the diagnosis and management of blunt pancreatic trauma (BPT).To correlate CT findings and management strategies as they relate to site and type of pancreatic injury and their outcomes.
Background
•Blunt pancreatic trauma (BPT) is uncommon, accounts for less than 2% of abdominal injuries.•Complicated by difficulty in establishing diagnosis, leading to delay in diagnosis and increased morbidity.•Very few reports have described clearly the significance and the limitations of the serum amylase and lipase level in diagnosing BPT.
Imaging findings OR Procedure details
•Hospital-based study conducted from MAY 2004 to JAN 2008.
•164 patients who underwent CT following blunt trauma prior to surgery were included in the study.
•Data analyzed by SPSS 15.
Selection Criteria of the patient:
•Patients with blunt abdominal trauma who underwent CT for evaluation of intra-abdominal injury prior to surgery.
Exclusion Criteria of the patient:
•Patients who did not have a follow up (laparotomy / follow up imaging if managed conservatively) were excluded.
COMPUTED TOMOGRAPHY:
•DIRECT FINDINGS •Pancreatic enlargement+/-
•Laceration (focal linear nonenhancement)+/-
•Contusion...
Conclusion
•CT is highly predictive for presence of injury, however can underestimate pancreatic injury.•Serum enzyme determinations support the diagnosis of BPT and can be reliable and cost effective as screening tools.•To avoid failure in the detection of BPT, the determination of serum amylase and lipase levels should be done more than 3 hours after trauma.•The principal cause of pancreas-specific morbidity after BPT is injury to the MPD.•CT is unreliable in diagnosing MPD injury and should not be used to guide therapy.•Initial selection of patients with isolated...
Personal Information
Author details:Dr. Abhishek Mahajan, MBBS,MDFellow in Cancer ImagingDept of Radiodiagnosis & ImagingTata Memorial HospitalDr E Borges RoadParelMumbaiMaharashtra400 012India(+919920354764)
[email protected]
References
Nick WV, Zollinger RW, Williams RD. The diagnosis of traumatic pancreatitis with blunt abdominal injuries. J Trauma 1965; 5:495-502.Olsen WR. The serum amylase in blunt abdominal trauma. J Trauma 1973; 13:200-204. Bradley EL, Young PR, Chang MC, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multi-institutional review. Ann Surg 1998; 227:861-869.Akhrass R, Yaffe M, Brandt CP, et al: Pancreatic trauma: a ten-year multi-institutional experience. Am Surg 1997; 63:598-603. Wong YC, Wang LJ, Lin BC, Chen CJ, Lim KE, Chen RJ....