Copyright ©The Author(s) 2016.
World J Radiol. Feb 28, 2016; 8(2): 159-173
Published online Feb 28, 2016. doi: 10.4329/wjr.v8.i2.159
Table 1 The American Association of Surgery for Trauma-organ injury scale pancreatic injury scale[25]
IHematoma: Minor contusion without duct injury
Laceration: Superficial laceration without duct injury
IIHematoma: Major contusion without duct injury or tissue loss
Laceration: Major laceration without duct injury or tissue loss
IIILaceration: Distal transection or parenchymal injury with duct injury
IVLaceration: Proximal transection1 or parenchymal injury involving ampulla or bile duct
VLaceration: Massive disruption of pancreatic head
Table 2 Computed tomography signs of pancreatic injury[9,10,12,27,38-41]
"Hard" signs/specific signs"Soft" signs/suggestive signs
Fracture of the pancreasFluid separating the splenic vein from posterior aspect of pancreas
Pancreatic lacerationFluid surrounding the superior mesenteric artery/(SMV cuff sign)
Focal or diffuse pancreatic enlargement/edemaFluid in the anterior and posterior pararenal spaces
Pancreatic hematomaFluid in transverse mesocolon and lesser sac
Active bleeding/extravasation of intravenous contrastInflammatory changes in peripancreatic fat and mesentery
Thickening of the left anterior renal fascia
Delayed signs
Pancreatic ductal dilatation
Pseudocyst formation/peripancreatic fluid collection
Table 3 Treatment options for isolated pancreatic injuries based on the American Association of Surgery for Trauma pancreas organ injury scale[2,14,60]
AAST gradeTreatment options
IObservation/conservative management
Simple external drainage
Omental pancreatorrhaphy and drainage
IIObservation/conservative management
Simple external drainage
Omental pancreatorrhaphy and drainage
IIIDistal pancreatectomy +/- splenectomy
Roux-en-Y distal pancreatojejunostomy
IVSimple drainage in damage control situations
Pancreatoduodenectomy (Whipple procedure)
Distal Roux-en-Y pancreatojejunostomy
Anterior Roux-en-Y pancreatojejunostomy
Endoscopically placed stent
Drainage in damage control situations