Pancreatic Injuries

  • Margherita Trinci
  • Eva Berardi
  • Giovanna Calabrese
  • Giovanni Maria Garbarino
  • Matteo Pignatelli
  • Vittorio Miele
Chapter

Abstract

The pancreas is a relatively uncommon organ to be injured in blunt trauma (0.4%) and often pancreatic lesions are associated with other abdominal organ injuries. Pancreatic lesions especially in adults occur in the event of high energy traumas as car accident, pedestrian injury, or other. In the pediatric patient, the lower thickness of the muscular wall exposes the pancreatic gland even in the case of low energy traumas such as “bicycle handlebars” lesion.

The clinical diagnosis of pancreatic trauma can be difficult, due the poverty of specific symptoms and of laboratory data, especially in the first few hours after the event when the symptoms of damage to other organs can be overwhelming. The delay in diagnosis can be caused by late complications and for this reason it is important to carry out an accurate assessment of the pancreatic parenchyma and the integrity of its duct. Diagnostic imaging utilizes the following study methods depending on the severity of the trauma and eventually for the follow-up: US-CEUS, CT, cholangio-MRI, Endoscopic Retrograde Cholangio-Pancreatography (ERCP).

Keywords

Trauma Trauma imaging Emergency radiology Blunt abdominal trauma Pancreatic trauma Parenchymal and ductal injury US CEUS CT CholangioMRI Endoscopic Retrograde Cholangio-Pancreatography ECPR  Trauma management 

References

  1. 1.
    Debi U, Kaur R, Prasad KK, et al. Pancreatic trauma: a concise review. World J Gastroenterol. 2013;19:9003–11. doi: 10.3748/wjg.v19.i47.9003.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Mahadevan V. Anatomy of the pancreas and spleen. Surgery (United Kingdom). 2016;34:261–5. doi: 10.1016/j.mpsur.2016.03.014.CrossRefGoogle Scholar
  3. 3.
    Menahem B, Lim C, Lahat E, et al. Conservative and surgical management of pancreatic trauma in adult patients. Hepatobiliary Surg Nutr. 2016;5:470–7. doi: 10.21037/hbsn.2016.07.01.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Rekhi S, Anderson SW, Rhea JT, et al. Imaging of blunt pancreatic trauma. Emerg Radiol. 2010;17:13–9. doi: 10.1007/s10140-009-0811-0.CrossRefPubMedGoogle Scholar
  5. 5.
    Miele V, Di Giampietro I, Ianniello S, et al. Diagnostic imaging in pediatric polytrauma management. Radiol Med. 2015;120:33–49. doi: 10.1007/s11547-014-0469-x.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Venkatesh SK, Wan JM. CT of blunt pancreatic trauma. A pictorial essay. Eur J Radiol. 2008;67:311–20. doi: 10.1016/j.ejrad.2007.07.003.CrossRefPubMedGoogle Scholar
  7. 7.
    Lahiri R, Bhattacharya S. Pancreatic trauma. Ann R Coll Surg Engl. 2013;95:241–5. doi: 10.1308/003588413X13629960045913.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kumar A, Panda A, Gamanagatti S. Blunt pancreatic trauma: a persistent diagnostic conundrum? World J Radiol. 2016;8:159–73. doi: 10.4329/wjr.v8.i2.159.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Bao W, She G, Duan Y. Diagnosis and management of high-grade pancreatic trauma: report of 14 cases. Indian J Surg. 2015;77:1222–6. doi: 10.1007/s12262-015-1258-z.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Nanashima A, Imamura N, Tsuchimochi Y, et al. Horizontal traumatic laceration of the pancreas head: a rare case report. Int J Surg Case Rep. 2017;31:119–23. doi: 10.1016/j.ijscr.2017.01.030.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Linsenmaier U, Wirth S, Reiser M, et al. Diagnosis and classification of pancreatic and duodenal injuries in emergency. Radiographics. 2008;28:1591–602. doi: 10.1148/rg.286085524.CrossRefPubMedGoogle Scholar
  12. 12.
    Panda A, Kumar A, Gamanagatti S, et al. Evaluation of diagnostic utility of multidetector computed tomography and magnetic resonance imaging in blunt pancreatic trauma: a prospective study. Acta Radiol. 2015;56:387–96. doi: 10.1177/0284185114529949.CrossRefPubMedGoogle Scholar
  13. 13.
    Melamud K, LeBedis CA, Soto JA (2015) Imaging of pancreatic and duodenal trauma. Radiol Clin N Am. 53:757–71.viii. doi: 10.1016/j.rcl.2015.02.009.CrossRefPubMedGoogle Scholar
  14. 14.
    Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics. 2004;24:1381–95.CrossRefGoogle Scholar
  15. 15.
    Raghuwanshi S, Gupta R, Vyas MM, et al. CT evaluation of acute pancreatitis and its prognostic correlation with CT severity index. J Clin Diagn Res. 2016;10:TC06–11. doi: 10.7860/JCDR/2016/19849.7934.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Paspulati RM. Multidetector CT of the pancreas. Radiol Clin N Am. 2005;43:999–1020. doi: 10.1016/j.rcl.2005.07.001.CrossRefPubMedGoogle Scholar
  17. 17.
    Vitellas KM, Keogan MT, Spritzer CE, et al. MR Cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics. 2000;20:939–57.CrossRefGoogle Scholar
  18. 18.
    Ansari NA, Ramalho M, Semelka RC, et al. Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: an update. World J Radiol. 2015;7:361–74. doi: 10.4329/wjr.v7.i11.361.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Tirkes T, Sandrasegaran K, Sanyal R, et al. Secretin-enhanced MR cholangiopancreatography: spectrum of findings. Radiographics. 2013;33:1889–906. doi: 10.1148/rg.337125014.CrossRefPubMedGoogle Scholar
  20. 20.
    Dhaka N, Samanta J, Kochhar S, et al. Pancreatic fluid collections: what is the ideal imaging technique? World J Gastroenterol. 2015;21:13403–10. doi: 10.3748/wjg.v21.i48.13403.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Halefoglu AM. Magnetic resonance cholangiopancreatography: a useful tool in the evaluation of pancreatic and biliary disorders. World J Gastroenterol. 2007;13:2529–34. doi: 10.3748/WJG.V13.I18.2529.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Miele V, Piccolo CL, Sessa B, et al. Comparison between MRI and CEUS in the follow-up of patients with blunt abdominal trauma managed conservatively. Radiol Med. 2016;121:27–37. doi: 10.1007/s11547-015-0578-1.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Pinto F, Miele V, Scaglione M, et al. The use of contrast-enhanced ultrasound in blunt abdominal trauma: advantages and limitations. Acta Radiol. 2014;55:776–84. doi: 10.1177/0284185113505517.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Pinto F, Valentino M, Romanini L, et al. The role of CEUS in the assessment of haemodinamically stable patients with blunt abdominal trauma. Radiol Med. 2015;120:3–11. doi: 10.1007/s11547-014-0455-3.CrossRefGoogle Scholar
  25. 25.
    Sessa B, Trinci M, Ianniello S, et al. Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT. Radiol Med. 2015;120:180–9. doi: 10.1007/s11547-014-0425-9.CrossRefGoogle Scholar
  26. 26.
    Miele V, Piccolo CL, Galluzzo M, et al. Contrast-enhanced ultrasound (CEUS) in blunt abdominal trauma. Br J Radiol. 2016;89(1061):20150823. doi: 10.1259/bjr.20150823.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Miele V, Piccolo CL, Trinci M, et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med. 2016;121:409–30. doi: 10.1007/s11547-016-0637-2.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Maeda K, Ono S, Baba K, et al. Management of blunt pancreatic trauma in children. Pediatr Surg Int. 2013;29:1019–22. doi: 10.1007/s00383-013-3402-9.CrossRefPubMedGoogle Scholar
  29. 29.
    Subramanian A, Dente CJ, Feliciano DV, et al. The management of pancreatic trauma in the modern era. Surg Clin North Am. 2007;87:1515–32. doi: 10.1016/j.suc.2007.08.007.CrossRefPubMedGoogle Scholar
  30. 30.
    Wilson RH, Moorehead RJ. Current management of trauma to the pancreas. Br J Surg. 1991;78:1196–202.CrossRefGoogle Scholar
  31. 31.
    Martín GM, Morillas PJ, Pino JC, et al. Reconstruction after pancreatic trauma by pancreaticogastrostomy. Int J Surg Case Rep. 2015;9:92–4. doi: 10.1016/j.ijscr.2015.02.046.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Hughey M, Taffel M, Zeman RK, et al. The diagnostic challenge of the sequelae of acute pancreatitis on CT imaging: a pictorial essay. Abdom Radiol (NY). 2017;42:1199–209. doi: 10.1007/s00261-016-0986-2.CrossRefGoogle Scholar
  33. 33.
    Lai Y, Wu P, Huang C, Wu C, et al. Hepatobiliary and pancreatic: intra-hepatic arterio-biliary fistula caused by blunt abdomen trauma. J Gastroenterol Hepatol. 2016;31:1672. doi: 10.1111/jgh.13433.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012;265:678–93. doi: 10.1148/radiol.12120354.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Margherita Trinci
    • 1
  • Eva Berardi
    • 2
  • Giovanna Calabrese
    • 1
  • Giovanni Maria Garbarino
    • 3
  • Matteo Pignatelli
    • 1
  • Vittorio Miele
    • 4
  1. 1.Department of Emergency RadiologyS. Camillo HospitalRomeItaly
  2. 2.Department of RadiologyS. Andrea Hospital, Sapienza UniversityRomeItaly
  3. 3.Department of SurgeryS. Andrea Hospital, Sapienza UniversityRomeItaly
  4. 4.Department of RadiologyCareggi University HospitalFlorenceItaly

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