Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Feb 28, 2016; 8(2): 159-173
Published online Feb 28, 2016. doi: 10.4329/wjr.v8.i2.159
Blunt pancreatic trauma: A persistent diagnostic conundrum?
Atin Kumar, Ananya Panda, Shivanand Gamanagatti
Atin Kumar, Ananya Panda, Shivanand Gamanagatti, Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Kumar A was responsible for deciding the overall contents and flow of information in the paper and editing the images; Panda A was responsible for the actual writing and organisng references and tables; Gamanagatti S gave inputs on contents and provided images.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Atin Kumar, MD, DNB, Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, Room no 63, New Delhi 110029, India.
Telephone: +91-98-68398507 Fax: +91-11-26588663
Received: June 1, 2015
Peer-review started: June 4, 2015
First decision: July 31, 2015
Revised: August 24, 2015
Accepted: December 13, 2015
Article in press: December 15, 2015
Published online: February 28, 2016

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.

Keywords: Computed tomography, Magnetic resonance imaging, Pancreatic trauma, Complications, Magnetic resonance cholangiopancreatography, Management, Pancreatic injury, Review

Core tip: Pancreatic trauma is an uncommon injury in blunt trauma abdomen. Despite improved multidetector computed tomography (CT) technology, early diagnosis of pancreatic trauma remains difficult. Moreover, pancreatic injury shows evolution with time which affects CT performance in early stages after injury. Diagnosis of pancreatic ductal injury is vital to decide operative vs non-operative management. Magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography has superseded encoscopic retrograde cholangio-pancreatography (ERCP) in evaluation of duct in acute injury. This review discusses injury mechanisms, laboratory diagnosis, CT and MRI evaluation, role of ERCP and contrast-enhanced ultrasound, management and complications of pancreatic trauma. Evolution of pancreatic injury has been specifically discussed as it has important management implications.