Case Of the Week (COW) 19 July 2015
Main Pancreatic duct injury with traumatic pancreatitis
Findings
MRCP- Complete transection of main pancreatic duct at the level of distal body with bulky and T2 Hyperintense distal body and tail------- Complete transection of MPD causing Traumatic pancreatitis
Discussion
Injury to the pancreas is relatively uncommon, occurring in less than 2% of blunt abdominal trauma patients,but may be associated with high morbidity and mortality, particularly if diagnosis is delayed. Hence, early diagnosis is critical The main source of delayed morbidity and mortality from pancreatic trauma is disruption of the pancreatic duct. Injuries that spare the pancreatic duct rarely result in morbidity or death . Disruption of the pancreatic duct is treated surgically or by therapeutic endoscopy with stent placement, while injuries without duct involvement are usually treated nonsurgically. Complications such as fistulas and abscesses are more likely to occur in patients with damage to the pancreatic duct. The risk of abscess or fistula formation in patients with disruption of the pancreatic duct approaches 25% and 50%, respectively Conversely, patients without duct injuries develop abscess or fistula in less than 10% of cases. As such, it is critical that imaging focus on the integrity of the duct or findings that suggest damage to the pancreatic duct. Magnetic resonance (MR) cholangiopancreatography can directly image the duct and is useful in evaluating pancreatic duct injury.
Contributed By:
Dr K Geetha, Prof S Babupeter
Barnard Institute of Radiology
Main Pancreatic duct injury with traumatic pancreatitis
Findings
MRCP- Complete transection of main pancreatic duct at the level of distal body with bulky and T2 Hyperintense distal body and tail------- Complete transection of MPD causing Traumatic pancreatitis
Discussion
Injury to the pancreas is relatively uncommon, occurring in less than 2% of blunt abdominal trauma patients,but may be associated with high morbidity and mortality, particularly if diagnosis is delayed. Hence, early diagnosis is critical The main source of delayed morbidity and mortality from pancreatic trauma is disruption of the pancreatic duct. Injuries that spare the pancreatic duct rarely result in morbidity or death . Disruption of the pancreatic duct is treated surgically or by therapeutic endoscopy with stent placement, while injuries without duct involvement are usually treated nonsurgically. Complications such as fistulas and abscesses are more likely to occur in patients with damage to the pancreatic duct. The risk of abscess or fistula formation in patients with disruption of the pancreatic duct approaches 25% and 50%, respectively Conversely, patients without duct injuries develop abscess or fistula in less than 10% of cases. As such, it is critical that imaging focus on the integrity of the duct or findings that suggest damage to the pancreatic duct. Magnetic resonance (MR) cholangiopancreatography can directly image the duct and is useful in evaluating pancreatic duct injury.
Contributed By:
Dr K Geetha, Prof S Babupeter
Barnard Institute of Radiology