Two Cases of Blunt Isolated Pancreatic Injury

Yasushi Nakajima, Hiroshi Arai*, Makoto Mitsusada, Sadaaki Shioiri*, Kaname Koyama*, Atsushi Matsuura* and Tatsurou Wakayama*

Department of Emergency and Critical Care Medicine and Department of Surgery*, Tokyo Metropolitan Hiroo General Hospital

Isolated pancreatic injury is rare in blunt abdominal injury. We report two cases of blunt isolated pancreatic injury due to domestic violence. Case 1: A 24-year-old woman presenting with a crushed epigastric region, alert and complaining of epigastric pain. Abdominal CT showed contusions and a rupture of the pancreas parenchyma. Endoscopic retrograde pancreatography (ERP) demonstrated main pancreatic duct injury. This case was diagnosed as "type IIIa pancreatic injury". In emergent surgery the pancreas parenchyma, including the main pancreatic duct was completely transected on the left border of the superior mesenteric vein. Considering that the patient had acute pancreatitis and DIC preoperatively, we undertook two-staged pancreatojejunostomy, which is for preservation of pancreatic function and external drainage of pancreatic juice to prevent pancreatic fistula. No abnormalities in both internal and external secretion of the pancreas were documented for 1.5 year after the second operation. Case 2: A 28-year-old woman presenting with blunt trauma, alert and complaining of upper abdominal pain after being kicked violently to the epigastric region and left abdomen. Abdominal CT scan showed a low-density area in the body of the pancreas, but no main pancreatic duct injury was found in ERP and MRCP. Under a diagnosis of type II pancreatic injury, we decided to observe without operation. Blunt pancreatic injury due to domestic violence must be suspected and evaluated based on the degree and location of impact.

Key words
blunt trauma, pancreatic injury, domestic violence

Reprint requests
Yasushi Nakajima Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Hiroo General Hospital
2-34-10 Ebisu, Shibuya-ku, 150-0013 JAPAN

Accepted
March 30, 2005

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