Delayed Presentation of Isolated Complete Pancreatic Transection as a Result of Sport-Related Blunt Trauma to the Abdomen

Abstract

Introduction: Blunt abdominal trauma is a rare but well-recognized cause of pancreatic transection. A delayed presentation of pancreatic fracture following sport-related blunt trauma with the coexisting diagnostic pitfalls is presented. Case Report: A 17-year-old rugby player was referred to our specialist unit after having been diagnosed with traumatic pancreatic transection, having presented 24 h after a sporting injury. Despite haemodynamic stability, at laparotomy he was found to have a diffuse mesenteric hematoma involving the large and small bowel mesentery, extending down to the sigmoid colon from the splenic flexure, and a large retroperitoneal hematoma arising from the pancreas. The pancreas was completely severed with the superior border of the distal segment remaining attached to the splenic vein that was intact. A distal pancreatectomy with spleen preservation and evacuation of the retroperitoneal hematoma was performed. Discussion/Conclusion: Blunt pancreatic trauma is a serious condition. Diagnosis and treatment may often be delayed, which in turn may drastically increase morbidity and mortality. Diagnostic difficulties apply to both paraclinical and radiological diagnostic methods. A high index of suspicion should be maintained in such cases, with a multi-modality diagnostic approach and prompt surgical intervention as required.

Diagnostic double strike in the emergency room - two cases of complete pancreatic ruptures due to bicycle handlebar injuries on two consecutive days

“…Diagnostic delay does easily occur in cases of blunt abdominal trauma, due to underestimation of the traumatic extent. Symptom-free and silent intervals can simulate an assumed recovery [ 6 , 7 ]. Both our patients underwent emergency distal pancreatectomy and required a prolonged stay in our intensive care unit due to sepsis and peritonitis.…”

Isolated Pancreatic Transection Secondary to Abdominal Blunt Trauma - A Case Report

“…[1] Ultrasound Scanning is useful as an inexpensive and noninvasive test for detecting free fluid in intraperitoneal region or a large hematoma, but due to the retroperitoneal location of the pancreas and its duct, any specific injury in that region cannot be seen clearly. The use of ultrasound screening in children is higher [11] However, Sato et al, demonstrated that nearly 80% of lesions to the pancreatic duct can be diagnosed by abdominal USG if done by an expert [12].…”

Isolated Distal Pancreatic Transection Secondary to an Abdominal Blunt Trauma - A Case Report

“…It is a low cost noninvasive test, submitting findings in real time [2,7]. In children the utility of the US appears to be higher [11]. Sato et al demonstrate that the 80% of the ductal lesions are diagnosticated by abdominal US in experts' hands [12].…”