The use of MRCP in the detection of pancreatic injuries after blunt trauma

Ragozzino, Alfonso; Manfredi, Roberto; Scaglione, Mariano; Ritis, Rosaria De; Romano, Stefania; Rotondò, Antonio

doi:10.1007/s10140-003-0278-3

Cited by 51 publications

(23 citation statements)

References 16 publications

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“…If the CT findings are inconclusive or continued suspicion of pancreatic injury remains, magnetic resonance cholangiopancreatography (MRCP) may provide a clear demonstration of pancreatic duct disruption. Although MRCP has been used in the initial assessment of otherwise stable trauma patients [8], in other series it has been shown to be unreliable early after injury [9]. The difficulty in performing endoscopic retrograde pancreatography in the acute setting, along with the associated risk of inducing iatrogenic pancreatitis in a traumatized patient, does not make this option favorable to most centers.…”

Section: Discussionmentioning

confidence: 99%

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

Healey

Dimarakis

Pai

et al. 2008

Case Rep Gastroenterol

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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.

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Section: Discussionmentioning

confidence: 99%

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

Healey

Dimarakis

Pai

et al. 2008

Case Rep Gastroenterol

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“…Ragozzino et al also reported that secretin-enhanced MRCP improved visualization of the non-dilated pancreatic duct. 28 These studies suggest that MRCP is a useful non-invasive modality. Newer technologies, like dynamic MRCP, probably parallel ERP in delineating pancreatic ductal injuries.…”

Section: Magnetic Resonance Cholangiopancreatography In Pancreatic Trmentioning

confidence: 99%

“…21 However, data on the role of MRCP in pancreatic trauma are limited. 6,21,[25][26][27][28][29] Fulcher et al studied 10 patients with suspected pancreatic injury following blunt trauma to the abdomen, and compared the MRCP findings with ERP (two patients), CT (10 patients), surgical findings (one patient) and clinical, biochemical or follow-up imaging (10 patients). 25 The pancreatic duct injury was detected in four patients.…”

Section: Magnetic Resonance Cholangiopancreatography In Pancreatic Trmentioning

confidence: 99%

“…Ragozzino et al studied accuracy of MRCP in five patients with pancreatic trauma. 28 In four patients, MRCP was performed within 24-48 h of the injury and in one patient it was performed 20 days later. In two patients with CT findings of deep laceration and parenchymal as well as peripancreatic collections, MRCP revealed integrity of the MPD.…”

Section: Magnetic Resonance Cholangiopancreatography In Pancreatic Trmentioning

confidence: 99%

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Endoscopic retrograde pancreatography in pancreatic trauma: Need to break the mental barrier

Bhasin

Rana

Rawal

2009

J of Gastro and Hepatol

101

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Pancreatic injury has a high morbidity and mortality. The integrity of the main pancreatic duct is the most important determinant of prognosis. Serum amylase, peritoneal lavage and computed tomography of the abdomen can assist with diagnosis but endoscopic retrograde pancreatography (ERP) is the most accurate investigation for diagnosing the site and extent of ductal disruption. However, it is invasive and can be associated with significant complications. Magnetic resonance cholangiopancreatography (MRCP) and secretin-enhanced MRCP probably parallel ERP in delineating pancreatic ductal injuries. They can also delineate the duct upstream to complete disruption, an area not visualized on ERP. In relation to therapy, endoscopic transpapillary drainage has been successfully used to heal duct disruptions in the early phase of pancreatic trauma and, in the delayed phase, to treat the complications of pancreatic duct injuries such as pseudocysts and pancreatic fistulae. Transpapillary drainage is especially effective in patients who have partial pancreatic duct disruption that can be bridged. Endoscopic transmural drainage has also been successfully used to treat post-traumatic pancreatic pseudocysts. Further large, prospective and randomized studies are required to adjudge the efficacy and long-term safety of pancreatic duct drainage in the treatment of post-traumatic pancreatic duct injuries.

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“…One caveat is that percutaneous drains should be clamped before SS-MRCP and the abdomen should be examined for any sinus tracts, which need to be monitored clinically or included in the images [33, 34]. …”

Section: Clinical Applicationsmentioning

confidence: 99%

Secretin-stimulated MR cholangiopancreatography: spectrum of findings in pancreatic diseases

et al. 2016

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MR cholangiopancreatography (MRCP) is an imaging technique that has evolved over the past 2 decades and that continues to have a fundamental role in the non-invasive detection of morphologic features of the pancreatic ducts. In several studies, MRCP has shown a good correlation with endoscopic retrograde cholangiopancreatography in the evaluation of diseases and anatomic variants of the pancreatic ductal system. However, in physiologic conditions the pancreatic ducts are not always easily recognisable. More recently, secretin-enhanced MRCP protocols have been developed for a more complete assessment of pancreatic ducts and glandular function, including monitoring of pancreatic flow dynamics and duodenal filling after pancreatic hormonal stimulation with secretin. The injection of this hormone causes temporary dilation of the pancreatic ducts, principally by increasing pancreatic exocrine secretions, and thus improving MRCP detection of the ducts and characterisation of pancreatic disorders and allowing the assessment of the exocrine pancreatic reserve. The purpose of this pictorial review is to summarise the technical aspects of secretin-stimulated MRCP, to report the secretin-stimulated MRCP findings of pancreatic duct abnormalities and to review the diagnostic capabilities of secretin-stimulated MRCP in various pancreatic ductal system conditions.Main Messages• MRCP has a fundamental role in the non-invasive detection of pancreatic ducts. • In physiologic conditions pancreatic ducts are not always well detected on MRCP. • Secretin injection causes temporary dilation of pancreatic ducts and thus improves MRCP detection. • Secretin-stimulated MRCP may allow the assessment of the exocrine pancreatic reserve. • Secretin increases the diagnostic capabilities of MRCP for evaluating pancreatic disorders.

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The use of MRCP in the detection of pancreatic injuries after blunt trauma

Cited by 51 publications

References 16 publications

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

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

Endoscopic retrograde pancreatography in pancreatic trauma: Need to break the mental barrier

Secretin-stimulated MR cholangiopancreatography: spectrum of findings in pancreatic diseases

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