Secondary signs of pancreatic injury are usually present (peripancreatic fat stranding and fluid, thickening of pararenal fascia, peripancreatic hematoma)












IMAGING
General Features
CT Findings
• Secondary signs of pancreatic injury or post-traumatic pancreatitis usually present even in absence of discrete contusion/laceration
Peripancreatic fat stranding and fluid with loss of normal peripancreatic fat planes almost always present

• Pancreatic contusion: Ill-defined focal hypoattenuation at site of injury
• Pancreatic laceration: Discrete linear cleft of hypoattenuation running through pancreas (usually perpendicular to long-axis of gland)
Often associated with distortion or irregularity of contour of pancreas and hypoenhancement of gland upstream from laceration

DIFFERENTIAL DIAGNOSIS
Shock Pancreas
• Part of hypoperfusion complex seen in severe traumatic injuries or in setting of severe hypotension
• Abnormally intense enhancement of pancreas, bowel wall, and kidneys, with decreased caliber of aorta and inferior vena cava, and diffuse dilatation of intestine with fluid
PATHOLOGY
General Features
• Etiology
May result from either penetrating or blunt trauma

– Mechanism in blunt trauma
Most commonly the result of motor vehicle collisions, but also falls, crush injuries, and assaults (with direct blow to abdomen)
Pancreatic injuries in children often due to blunt trauma, including trauma from bicycle handlebar, motor vehicle crash, or child abuse
Usually result from anterior/posterior compression force to abdomen (more rarely lateral force vector)



CLINICAL ISSUES
Presentation
Treatment
• AAST grades III, IV, and V (blunt trauma): Require surgery within 24 hours
Grade III: Usually distal pancreatectomy and splenectomy (with spleen preservation in children), although pancreas may be preserved with “clean” pancreatic lacerations











































































