title: Blunt pancreatic trauma: A persistent diagnostic conundrum?
abstract: Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography (CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging (MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful non-operative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma.
authors.affiliation: Atin Kumar, Ananya Panda, Shivanand Gamanagatti, Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Atin
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Atin Kumar, Ananya Panda, Shivanand Gamanagatti, Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Ananya
authors.initials: A
authors.lastname: Panda
authors.affiliation: Atin Kumar, Ananya Panda, Shivanand Gamanagatti, Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Shivanand
authors.initials: S
authors.lastname: Gamanagatti
keywords: Complications; Computed tomography; Magnetic resonance cholangiopancreatography; Magnetic resonance imaging; Management; Pancreatic injury; Pancreatic trauma; Review