Delayed diagnosis and treatment of high grade blunt pancreatic trauma. Case report and review of literature.


COD: 06_2017_11-2709 Categorie: ,

Myftar Torba, Arben Gjata, Francesco Rulli, Ilir Kajo, Sotir Ceka, Tajar Asqeri

Ann Ital Chir, 2017 88, 6: 539-545
Epub Ahead of Print November 29, 2017

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INTRODUCTION: Despite technological advancement, high grade pancreatic injuries following blunt abdominal trauma
continues to remain a disease that is associated with high morbidity and mortality rates, particularly in cases of delayed
diagnosis. The aim of this paper was the presentation of delayed diagnosis and treatment peculiarities of high grade pancreatic
trauma and a review of literature.
CASE REPORT: A 55-years old man, involved in motor vehicle crashes, was referred to our level I trauma center.
Hemodynamically stable. Abdominal physical exam, laboratory and focused abdominal sonography for trauma were normal.
First total body multidetector CT scan, performed only after 24 hours, showed almost complete left pneumothorax,
left third to fifth rib fractures and subcutaneous emphysema. Left chest tube was applied. On the eighth post-traumatic
day, the general condition of the patient started to deteriorate. The patient showed abdominal pain, fever, nausea,
vomiting, and bilateral flank ecchymosis. Only the third CT scan performed, on twelfth day, after the peritoneal signs,
changes in blood and biochemical parameters appear, we revealed linear laceration and hypo-attenuation area of the neck
and a part of distal body pancreas. In laparotomy fat necrosis, giant retroperitoneal abscess, necrosis of the neck and distal
body of the pancreas, was found. Distal pancreatectomy with splenectomy was performed. Postoperative course with
extensive wound infection and necrotic leakage from peripancreatic drain was complicated. The patient was discharged
two months after his operation without any events.
CONCLUSION: On time diagnosis of pancreatic trauma, especially in polytrauma patients, continues to remain a challenge
for trauma surgeons. Main pancreatic duct injury is an important prognostic factor and the major one determining
therapeutic approaches. Adequate surgical approaches decrease morbidity and mortality in pancreatic trauma.