- In the acute setting, pancreatic injuries may result in death due to associated vascular injuries.
- Delayed morbidity and mortality are usually caused by complications resulting from disruption of the pancreatic duct.
- Duct injury may lead to complications such as abscess, pancreatic pseudocyst, fistula, and pancreatitis.
- Pancreatic injuries may be difficult to diagnose clinically.
- Although uncommon, early diagnosis is crucial, since delayed complications such as fistula, abscess, sepsis, and hemorrhage may lead to significant mortality, occurring in up to 20% of cases.
- Death due to delayed complications is usually due to sepsis and multiorgan failure.
- The pancreas is vulnerable to crushing injury in blunt trauma due to impact against the adjacent vertebral column.
- Two-thirds of pancreatic injuries occur in the pancreatic body, and the remainder occur equally in the head, neck, and tail.
- Isolated pancreatic injuries are rare, and associated injuries, especially to the liver, stomach, duodenum, and spleen, occur in over 90% of cases.
- In adults, over 75% of blunt injuries to the pancreas are due to motor vehicle collisions.
- In children, bicycle injuries are common, and child abuse may result in pancreatic injuries in infants.
- The main source of delayed morbidity and mortality from pancreatic trauma is disruption of the pancreatic duct. Injuries that spare the pancreatic duct rarely result in morbidity or death.
- Disruption of the pancreatic duct is treated surgically or by therapeutic endoscopy with stent placement, while injuries without duct involvement are usually treated nonsurgically.
 Imaging Findings
- Direct signs of pancreatic injury include pancreatic laceration, transection, and comminution.
- Fluid collections, such as hematomas, pseudocysts, and abscesses, are often seen communicating with the pancreas at the site of fracture or transection.
- Focal enlargement of the pancreas and peripancreatic fluid are suggestive of pancreatic injury.
- Peripancreatic fat stranding, hemorrhage, and fluid between the splenic vein and pancreas are useful secondary signs.
Patient #1: Pancreatic transection and pseudocyst formation from motor vehicle accident
 See Also
 External Links
- Avneesh Gupta, Joshua W. Stuhlfaut, Keith W. Fleming, Brian C. Lucey, and Jorge A. Soto. Blunt Trauma of the Pancreas and Biliary Tract: A Multimodality Imaging Approach to Diagnosis. RadioGraphics 2004 24: 1381-1395.