![]() ![]() ![]() The main pancreatic duct of Wirsung runs transversely through the entirety of the pancreas and is responsible for delayed complications when disrupted. The second is the acinar or exocrine portion that secretes lipase, amylase, and proteolytic enzymes into the duodenum along with bile at the ampulla of Vater through the sphincter of Oddi. The first is the endocrine pancreas that houses alpha, beta, and gamma cells responsible for glucagon, insulin, and somatostatin respectively. It is long, J-shaped, lobulated, and is divided histologically into two parts. The pancreas has some innate protection given its location in the dorsal aspect of the abdomen. The pancreas is a retroperitoneal organ which lies in transverse orientation in the epigastric region near the level of L1-L2. This chapter is a concise overview to further aid the care for patients who suffer traumatic pancreatic injury. A high degree of suspicion and comprehensive knowledge is required to identify, classify, and treat traumatic pancreatic effectively. Incorrect classification deters proper intervention and management. A delay in diagnosis leads to complications such as infection, pseudocysts, abscess, duct stricture, peritonitis, and endocrine/exocrine insufficiency which are associated with high morbidity and mortality. Diagnostic testing may require magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). Post-traumatic pancreatitis may not cause alterations in blood or edema for several hours after the initial event. Unlike the liver, kidney or spleen, conventional imaging modalities miss subtle findings associated with pancreatic injury. “Eat when you can, sleep when you can, and don’t mess with the pancreas." This age-old surgical mantra is a saying to live by, but what happens if the pancreas has already been “messed with?" Pancreatic trauma is a rare but potentially catastrophic injury that can be very difficult to diagnose. This activity reviews the evaluation and management of pancreatic trauma and highlights the importance of an interprofessional team in caring for patients with traumatic pancreatic injury. ![]() A delay in diagnosis can lead to complications such as infections, pseudocysts, abscesses, duct strictures, peritonitis, and endocrine/exocrine insufficiency which are associated with high morbidity and mortality. Conventional imaging modalities miss subtle findings associated with a pancreatic injury, and post-traumatic pancreatitis may not cause measurable effects until several hours after the initial event. Progression of untreated bowel ischemia leads to bowel necrosis, perforation, pneumoperitoneum, peritonitis, and sepsis 1.Pancreatic trauma is a rare but potentially catastrophic injury that can be very difficult to diagnose. Surgery is required to remove the devitalized bowel segment. Around one-fifth of patients with mesenteric avulsion injuries have a lumbar hernia 1,3. The presence of a traumatic abdominal wall hernia, especially lumbar hernia, should raise the suspicion of an associated surgically significant mesenteric injury 1. Signs that suggest a surgically significant mesenteric and bowel injury in general include active bleeding (contrast extravasation) from a mesenteric vessel, abnormal decreased contrast enhancement of bowel wall, and interloop fluid 1,3. Radiographic features CTīucket handle injuries are frequently difficult to detect on initial trauma CT. Pathologyīucket handle injuries are considered the highest grade of blunt mesenteric injury due to devascularization, as compared to lacerations or hematomas without devascularization 1,3.Ĭommon sites of injury include the proximal jejunum (near the ligament of Treitz) and the distal ileum (near the ileocecal valve) due to points of fixation between a mobile peritoneal bowel segment and the retroperitoneum 1. The injury is commonly missed at the time of trauma and patients present one to several days later due to the development of bowel ischemia and necrosis. Other mechanisms include bicycle handlebar injury, fall from a height, or assault 1,2. The most common mechanism of injury involves a seatbelt-restrained driver or passenger in a motor vehicle crash 1,2. ![]()
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