title: Successful management of a blunt pancreatic trauma by endoscopic stent placement.
abstract: The present study reports a case involving a 17-year-old man who was brought to the emergency department of our hospital with severe upper abdominal pain following a blow received in a rugby game. Emergency computed tomography (CT) revealed severe pancreatic neck injury, and the patient was subsequently given conservative treatment in the High Care Unit. Forty-eight hours later, follow-up enhanced CT revealed that the pancreas was clearly lacerated and the amount of peripancreatic fluid was increasing; furthermore, serum amylase and elastase levels were elevated. Endoscopic retrograde pancreatography revealed that contrast medium in the main pancreatic duct (MPD) had leaked to the parenchyma, indicating an MPD injury. To prevent traumatic pancreatitis from worsening, a stent was inserted endoscopically to a site distal to the injured portion of the MPD. Thereafter, the patient's condition dramatically improved, and his serum amylase levels returned to normal. CT revealed that the apparent pancreatic edema and peripheral fluid were also decreased. During a short-term follow-up period of 6 months, removal of the stent was uneventfully carried out and the patient did not develop any exocrine or endocrine insufficiency. We suggest that, in some cases, endoscopic management of traumatic pancreatic duct disruption is feasible and effective.
authors.affiliation: Department of Surgery, Tsuru Municipal Hospital, 5-1-55, Tsuru, Yamanashi, 402-0056, Japan. hirotaka@yamanashi.ac.jp.|Department of Surgery 1, University of Yamanashi, Faculty of Medicine, Chuo, Japan. hirotaka@yamanashi.ac.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Okamoto
authors.affiliation: Department of Internal Medicine, Tsuru Municipal Hospital, Tsuru, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Hosaka
authors.affiliation: Department of Surgery 1, University of Yamanashi, Faculty of Medicine, Chuo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Department of Surgery, Tsuru Municipal Hospital, 5-1-55, Tsuru, Yamanashi, 402-0056, Japan.|Department of Surgery 1, University of Yamanashi, Faculty of Medicine, Chuo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Wakana
authors.affiliation: Department of Surgery, Tsuru Municipal Hospital, 5-1-55, Tsuru, Yamanashi, 402-0056, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawashima
authors.affiliation: Department of Surgery, Tsuru Municipal Hospital, 5-1-55, Tsuru, Yamanashi, 402-0056, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Fukasawa
keywords: Endoscopic retrograde pancreatography; Pancreatic duct stent; Traumatic pancreatic injury