Blunt pancreatic trauma: evaluation with MDCT technology

Abstract

The purpose of this paper is to determine the relative frequency of multi-detector CT (MDCT) findings of pancreatic injury in blunt trauma and to determine their diagnostic accuracy in predicting main pancreatic duct injury. Fifty-three patients (31 male, 22 female; mean 44.1 years) with blunt trauma and admission MDCT findings suspicious for pancreatic injury or who underwent MDCT and had a discharge diagnosis of pancreatic trauma were included in this study. Two radiologists reviewed all images and recorded findings suspicious for pancreatic injury, which were subsequently compared to surgical findings to generate diagnostic accuracy. MDCT imaging findings suggestive of pancreatic injury included low attenuation peripancreatic fluid (n = 51), hyperattenuating peripancreatic fluid (n = 13), pancreatic contusion (n = 7), active hemorrhage (n = 2), and pancreatic laceration (n = 16). Diagnostic accuracy of the various imaging findings varied for diagnosing main duct injury; there were highly sensitive, nonspecific imaging findings such as the presence of low attenuation peripancreatic fluid (sensitivity, 100 %; specificity 4.9 %) as well as insensitive, specific findings such as visualizing a pancreatic laceration involving >50 % of the parenchymal width (sensitivity, 50 %; specificity, 95.1 %). In the setting of blunt abdominal trauma, MDCT imaging findings can be grouped into two categories for determining integrity of the main pancreatic duct: indirect, highly sensitive but nonspecific findings and direct, specific but insensitive findings. Awareness of the clinical implications of the various MDCT imaging findings of pancreatic trauma is useful in interpreting their significance.

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

“…Of those with missed DI, 83% had subtle CT findings on retrospective review [85]. Careful CT-scan interpretation with clinical correlation is mandatory to avoid delayed diagnosis and treatment with increased morbidity and mortality [28, 60, 61, 67, 79, 80, 82, 86–90]. In fact, isolated periduodenal fluid or hematoma visualized on admission abdominal CT-scan does not necessitate immediate exploration [83, 91–94].…”

“…The ERCP may play a role in duodeno-pancreatic trauma in order to avoid late-diagnosis and/or treatment both in adult and pediatric patients [10, 15, 41–43, 48–52, 58–60, 62–64, 67, 68, 70, 76–78, 90, 97, 101, 127–149]. It is an invasive procedure with 3–14% risk of post-procedure pancreatitis and 0.2–1% mortality rate [6, 10, 11, 40, 41, 45, 49, 51–53, 58, 61–64, 67, 68, 70–72, 75, 77, 78, 97, 128, 130, 133, 134, 137–140, 142, 144, 146, 148–157].…”

Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience

“…Signs of pancreatic injuries may be indirectly suspected or directly depicted at imaging. Indirect signs may be considered the trajectory of injury through the region of the pancreas and the presence of peripancreatic fat stranding (1).…”

“…Traumatic pancreatic injuries typically occur from acute penetrating or blunt abdominal trauma. They are considered rare and occur only between 0.2-12% of acute blunt abdominal trauma (1-5) with a mortality rate up to 30%, and a morbidity of 60% (1,4,6).…”

Blunt abdominal trauma. Pancreatic injury. Part 4

“…К прямым компьютерно-томографическим признакам ППЖ относят интенсивное кровотечение из ПЖ, ее гематому или разрыв, локальное или диффузное увеличение органа или его отек, пониженное накопление контрастного вещества. Косвенными признаками ППЖ считают жидкостные скопления в забрюшинном пространстве, отек парапанкреатической клетчатки, утолщение переднего листка почечной фасции, воспалительные изменения парапанкреатической клетчатки или брыжейки, жидкость в сальниковой сумке, рядом с поперечной ободочной кишкой, верхней брыжеечной артерией или селезеночной веной, свободную жидкость в брюшной полости [45][46][47]. Не все признаки позволяют установить степень ППЖ, многие из них являются неспецифическими [48], однако они заставляют продолжить обследование.…”