Diagnosis and management of blunt pancreatic ductal injury in the era of high-resolution computed axial tomography.
BACKGROUND
Blunt pancreatic ductal injury is an uncommon but potentially morbid injury that can be difficult to diagnose and manage. Computed axial tomography (CAT) scan has historically been unreliable for the detection of ductal injury, but the advent of high-resolution CAT should improve diagnostic accuracy.


METHODS
From our prospectively maintained trauma registry, consecutive patients who had a diagnosis of blunt pancreatic injury with or without a subsequent laparotomy during the time period from January 1995 through December 2004 were retrospectively reviewed. Pancreatic ductal injury was treated exclusively with distal pancreatic resection (DPR) without adjunctive endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography.


RESULTS
Of 50 patients with blunt pancreatic injury, 33 patients had both preoperative CAT scan and laparotomy. Although the CAT scan interpretation and operative findings corresponded precisely for all pancreatic injuries in only 55% of cases, CAT scan was 91% sensitive and 91% specific for identifying pancreatic ductal injury. Eleven patients with confirmed pancreatic ductal injury underwent DPR. There were no postoperative pancreas-related deaths and only 1 pancreas-related complication among survivors, a patient with a low-output pancreatic fistula that resolved after 5 weeks.


CONCLUSIONS
Blunt pancreatic ductal injury may be accurately diagnosed with preoperative CAT scan, without adjunctive endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography, and is effectively and safely treated with DPR.
Teh
Swee H
SH
Department of Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR 97239, USA.
Sheppard
Brett C
BC
Mullins
Richard J
RJ
Schreiber
Martin A
MA
Mayberry
John C
JC
D006801:Humans; D010183:Pancreatic Ducts / Q000293:injuries*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery*