Pancreatic Trauma

Aka: Pancreatic Trauma, Injury of the Pancreas

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II. Pathophysiology

  1. Rarely injured due to its fixed and protected position in the Retroperitoneum

III. Causes

  1. Blunt injury to the epigastrium (e.g. Bicycle handlebar injury)

IV. Symptoms

  1. Nausea or Vomiting
  2. Localized Epigastric Pain radiating into the chest and Shoulders
    1. Biphasic pain timing
    2. Pain worse with initial injury and subsides over subsequent 2 hours
    3. Pain recurrs and worsens 6-8 hours after injury

V. Signs

  1. Abdominal Wall Ecchymosis
  2. Focal abdominal tenderness
  3. Abdominal guarding
  4. Abdominal Rebound Tenderness

VI. Labs

  1. Comprehensive Metabolic Panel
  2. Complete Blood Count
  3. Serum Lipase

VII. Imaging

  1. CT Abdomen and Pelvis with IV Contrast
    1. First-line study in suspected pancreatic injury
  2. Endoscopic Retrograde Cholangiopancreatography (ERCP) or MRCP
    1. Consider in suspected pancreatic duct injury (missed on CT Abdomen)

VIII. Management

  1. Aggressive intravenous hydration (Lactated Ringers)
  2. Correct Electrolyte abnormalities
  3. Evaluate for associated intraabdominal injuries

IX. Prognosis

  1. Pancreatic Trauma is associated with increased morbidity and mortality

X. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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