Pancreatic Trauma


Pancreatic Trauma, Injury of the Pancreas

  • Pathophysiology
  1. Rarely injured due to its fixed and protected position in the Retroperitoneum
  • Causes
  1. Blunt injury to the epigastrium (e.g. Bicycle handlebar injury)
  • 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
  • Signs
  1. Abdominal Wall Ecchymosis
  2. Focal abdominal tenderness
  3. Abdominal guarding
  4. Abdominal Rebound Tenderness
  • Labs
  1. Comprehensive Metabolic Panel
  2. Complete Blood Count
  3. Serum Lipase
  • 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)
  • Management
  1. Aggressive intravenous hydration (Lactated Ringers)
  2. Correct Electrolyte abnormalities
  3. Evaluate for associated intraabdominal injuries
  • Prognosis
  1. Pancreatic Trauma is associated with increased morbidity and mortality
  • References
  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21