Emergency Body CT > Trauma > Pancreas


Pancreas

Pancreatic injuries account for 3-10% of all abdominal injuries. The mechanism of injury usually involves compression between the spine and abdominal wall during a forceful blow to this area. Pancreatic injuries are often associated with other injuries and carry a relatively high mortality rate, approximately 25%. 50% of pancreatic trauma related deaths are due to hypovolemic shock from major visceral hemorrhage. For this reason, rapid and accurate diagnosis of pancreatic injury is vital. Pancreatic laceration is often subtle particularly immediately after injury. If undiagnosed, leakage from pancreatic duct can lead to peripancreatic fluid and pancreatic pseudocyst.

General CT findings of pancreatic injury include:
1. Linear hypodensity extending through the pancreatic peranchyma
2. Peripancreatic fluid anterior anterior to pancreas or surrounding the splenic vein


Pancreatic laceration (arrow).



Pancreatic pseudocyst (arrow) resulting from
fluid leaking from a pancreatic laceration.



The CT appearance of the pancreas may be normal after pancreatic trauma, especially during the first 12 hours. In such cases, rescanning the patient in 12-24 hours may be helpful if there is continued clinical suspicion of pancreatic injury.

Injury to the pancreatic duct is the chief factor affecting management in pancreatic injury cases. Injury to the pancreatic duct can result in the delayed formation of a pancreatic pseudocyst (above image). the formation of a pancreatic psuedocyst is a complication of a pancreatic laceration. Delayed imaging can be used to rule out this potential complication.

 

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