Surgical Science, 2011, 2, 246-247
doi:10.4236/ss.2011.25054 Published Online July 2011 (http://www.SciRP.org/journal/ss)
Pancreatic Body Fracture does not Necessarily Imply Loss
of Ductal Integrity Following Blunt Trauma Abdomen
—A Rare Image
Disha Syal1, Arindam Ghosh2
1Department o f S urg e ry, Punjab Institute of Medical Sciences, Jalandhar, India
2Department o f S urg e ry, SPS Apollo Hospitals, Ludhiana, India
Received February 28 , 20 1 1; revised April 27, 2011; accepted May 10, 2011
Abstract
Pancreatic injuries can result in significant morbidity and mortality if missed or unnoticed and also pose a
great challenge in terms of diagnosis and treatment. We present a case of an 11 year old boy presenting with
history of blunt trauma abdomen following handle bar injury. He had signs of abdominal distension and
CECT of the abdomen showed transection of the pancreas in the region of junction between the body and tail.
On exploratory laparotomy there was rupture at junction of body and tail of pancreas with intact pancreatic
duct and a spleen preserving distal pancreatectomy was performed. In the presence of an intact pancreatic
duct conservative management should be offered however this patient underwent spleen preserving distal
pancreatectomy because of pancreatitis and necrosis ensuing in the pancreatic remnant margin. Hence, com-
plete transection does not necessarily mean loss of ductal integrity and decision to preserve or remove the
distal pancreas should not be based merely on ductal integrity but probably other factors also i.e. pancreatitis
and necrosis.
Keywords: Blunt Trauma Abdomen, Pancreatic Body Fracture, Management, Intact Pancreatic Duct
1. Case Report
An 11 year old boy presented with history of blunt trau-
ma abdomen following handle bar injury while riding a
bicycle and developed pain in right upper abdomen,
vomiting followed by abdominal distension. On exami-
nation he had pulse rate of 102/minute with tenderness
and guarding in epigastrium and left hypochondrium and
generalized abdominal distension.
He was investigated with complete blood co unts, liver
function tests and renal function tests which were normal.
A contrast enhanced Computerized tomography (CECT)
of the abdomen was performed which showed transec-
tion of the pancreas in the region of junc tion between the
body and tail. Moderate amount of free fluid was present
mainly in the pelvis (Figure 1).
He underwent exploratory laparotomy which revealed
peritonitis with saponification, mild hemoperitoneum,
hematoma in transverse mesocolon, rupture at junction
of body and tail of pancreas with intact pancreatic duct
(Figure 2), splenic artery and vein. A spleen preserving
distal pancreatectomy was performed (Figure 3). Fol-
lowing this patient had an uneventful recovery.
Pancreatic
transection
Figure 1. Contrast enhanced CT scan of the abdomen show-
ing complete transection at the junction of body and tail of
pancreas.

D. SYAL ET AL.247
Figure 2. Complete transection of pancreas at junction of
body and tail with an intact pancreatic duct.
Figure 3. Spleen preserving distal pancreatectomy with
ligated pancreatic duct.
2. Discussion
Following blunt trauma abdomen, the incidence of pancreatic
injuries is very low as compared to other solid viscera injuries
with rates of less than 1% reported of all trauma admis-
sions [1]. The overall mortality rate reported for blunt
pancreatic trauma varies between 16% to 20% [2]. Op-
timal management whether operative or nonoperative
depends on the grade of pancreatic injury and ductal in-
tegrity.
This patient underwent exploration in view of perito-
neal signs and although the pancreatic duct was intact,
spleen preserving distal pancreatectomy was performed.
Traditionally, in the presen ce of an intact pancreatic duct
conservative management should be offered, this patient
underwent spleen preserving distal pancreatectomy be-
cause of pancreatitis and necrosis ensuing in the pancre-
atic remnant margin. Hence, complete transection does
not necessarily mean loss of ductal integrity and decision
to preserve or remove the distal pancreas should not be
based merely on ductal integrity but probably other fac-
tors also i.e. pancreatitis and necrosis.
3. References
[1] R. Akhrass, M. B. Yaffe, C. P. Brandt, M. Reigle, W. F.
Fallon Jr. and M. A. Malangoni, “Pancreatic Trauma: A
Ten-Year Multi-Institutional Experience,” The American
Journal of Surgery, Vol. 63, No. 7, 1997, pp. 598-604.
[2] D. H. Wisner, R. L. Wold and C. F. Frey, “Diagnosis and
Treatment of Pancreatic Injuries,” Archives of Surgery,
Vol. 125, No. 9, 1990, pp. 1109-1113.