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February 2011

Normal pancreas after blunt abdominal trauma??????
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Clinical information

The boy had fallen of his bike and had sustained a blunt abdominal trauma by the handle bar of his bike 10 hours prior to the ultrasound examination. He was hemodynamically stable, but had pain in his left upper abdomen.

Ultrasound Images & Clips

Normal pancreas after a blunt abdominal trauma

Transverse image of the pancreas. There is a minimal contour irregularity of the anterior aspect of the pancreas
Transverse image of the pancreas. There is a minimal contour irregularity of the anterior aspect of the pancreas
Transverse image through the lower abdomen shows some blood around the bladder
Transverse image through the lower abdomen shows some blood around the bladder
Longtudinal image of the lower abdomen showing some fluid / blood
Longtudinal image of the lower abdomen showing some fluid / blood
No fluid around the liver (Morrisons pouch)
No fluid around the liver (Morrisons pouch)
No fluid around the normal looking spleen
No fluid around the normal looking spleen
No fluid around the spleen and left kidney transverse
No fluid around the spleen and left kidney transverse
Transverse image of the spleen with some fluid around the tail
Transverse image of the spleen with some fluid around the tail
Transverse image of the pancreas. No flow in the fluid around the tail. Normal splenic vein
Transverse image of the pancreas. No flow in the fluid around the tail. Normal splenic vein
Although we had advised a control examination the next day,
Although we had advised a control examination the next day,
Transverse image of the pancreatic rupture
Transverse image of the pancreatic rupture
videoclip
videoclip
There is now a larger fluid collection around the pancreatic tail
There is now a larger fluid collection around the pancreatic tail
There is now a larger fluid collection around the pancreatic tail. Transverse view
There is now a larger fluid collection around the pancreatic tail. Transverse view
videoclip
A CT scan showed the same findings
Pancreas after percutaneous drainage with the drain next to the pancreas tail
Pancreas after percutaneous drainage with the drain next to the pancreas tail
Pancreas after percutaneous drainage with a small effusion and the drain next to the pancreas tail
Pancreas after percutaneous drainage with a small effusion and the drain next to the pancreas tail
Pancreas after percutaneous drainage of the effusions and conservative treatment
Pancreas after percutaneous drainage of the effusions and conservative treatment
The site of the rupture is still visible as an irregularity of the contour
The site of the rupture is still visible as an irregularity of the contour
The pancreatic duct in the distal part of the pancreas can be followed to the sie of rhe rupture
The pancreatic duct in the distal part of the pancreas can be followed to the sie of rhe rupture
The fluid collection between the pancreatic tail and the splen is gone
The fluid collection between the pancreatic tail and the splen is gone
Detail of the pancreatic tail without effusion
Detail of the pancreatic tail without effusion

Conclusion

Acute pancreatic ruptures are difficult to diagnose with ultrasound. When there is no blood in the defect, they can easily be overlooked. Ultrasound is very sensitive in detecting fluid, but parenchymal lesions can sometimes be missed. CT is more sensitive than ultrasound in detecting parenchymal lesions. The patient was discussed with a  larger pediatric trauma centre, but because he remained hemodynamically stable the treatment of choice remained conservative treatment. The fluid collections that developed were percutaneously drained under ultrasound guidance.

References            
Isolated traumatic pancreatic rupture.Tsai MT, Sun JT, Tsai KC, Lien WC.
Am J Emerg Med. 2010 Jul;28(6):745.e3-4


Percutaneous drainage treatment of traumatic pancreatic rupture with pancreatic transection.Martinez-Ramos D, Cifrián-Pérez M, García-Vila JH, Salvador-Sanchís JL, Hoashi JS.
Gastroenterol Hepatol. 2010 Feb;33(2):102-5.

Details

  • Sex: Male
  • Age: 12

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  • Fujifilm Ultrasound System
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photo Taco Geertsma
Author

Dr. Taco Geertsma

Retired Radiologist, Gelderse Vallei Hospital

Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.

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