Lucía Gil Cidoncha (Madrid / ES), María Eugenia Torguet Muñoz (Madrid / ES), Celia Fidalgo Martínez (Madrid / ES), Belen Aguado Castillo (Madrid / ES), Eva Iglesias García (Madrid / ES), Miguel Suárez Sánchez (Madrid / ES), Pilar Martín Rodrigo (Madrid / ES), Marcos Casas Sánchez (Madrid / ES), Manuel Fernández Rodríguez (Madrid / ES), Cristián Grillo Marín (Madrid / ES), Javier Callau Pontaque (Madrid / ES), José Luis Lucena de la Poza (Madrid / ES)
Abstract text (incl. references and figure legends)
Case history
A 36-year-old man was admitted to the emergency department with epigastric pain after being kicked in the abdomen the day before.
Clinical findings
HD stable(BP 138/78mmHg,HR 80).PE:epigastric palpation-induced pain without abdominal guarding.
Results
Laboratory tests:leukocytosis.Elevated amylase (1032.00U/L) and lipase (1402 U/L).
CT:Laceration and hematoma in pancreatic body-neck junction.Peripancreatic hematoma.
MRCP:Incomplete laceration in the pancreatic body.Peripancreatic collection.Disruption vs obliteration of the main pancreatic duct in the neck-body.
EUS:Complete disruption of the pancreatic duct in the body,14cm pseudocyst.
Diagnosis
Blunt pancreatic trauma AAST grade III
Therapy and Progressions
Conservative management.EUS confirmed disruption as well as a pancreatic pseudocyst, so a transgastric metal stent was placed.CT control revealed decreased collection and the patient was discharged 23 days after admission. Subsequently, a control EUS was performed and the metal stent was replaced by a plastic one.Resolution of the collection was confirmed by CT.
Comments
The pancreas is an uncommon organ to be injured in trauma. Although MRCP is the noninvasive imaging method of choice when evaluating for pancreatic duct injury, ERCP remains important due to its potential to direct image-guided therapy. As endoscopic techniques have improved, endoscopic stenting of isolated pancreatic duct injuries is being considered rather than surgery.Transgastric drainage is the gold standard for pseudocysts.
References
Petrone P,et al.Traumatismos de páncreas:manejo y revisión de la literatura.Cir Esp.2016
Björnsson B,Kullman E,Gasslander T,SandströmP.Early endoscopic treatment of blunt traumatic pancreatic injury.Scand J Gastroenterol 2015
Debi U,Kaur R,Prasad KK,Sinha SK,Sinha A,Singh K.Pancreatic trauma:a concise review.World J Gastroenterol.2013 Dec
Fig1.MRCP:peripancreatic collection and disrupted duct.Fig2.EUS:transgastric stent
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