February 2011

Normal pancreas after blunt abdominal trauma??????

Clinical Info

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 with some fluid / blood anterior of the bladder
Transverse image through the lower abdomen with some fluid / blood anterior of the bladder
Longtudinal image of the lower abdomen showing some fluid / blood cranial to the bladder
Longtudinal image of the lower abdomen showing some fluid / blood cranial to the bladder
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 pancreas with some fluid around the tail
Transverse image of the pancreas with some fluid around the tail
Transverse image of the pancreas. No flow in the fluid around the tail. Normal splenic vein. A partial splenic rupture was considered the most likely diagnosis. Because the patient was stable with minor symptoms, we advised a control examination the follo
Transverse image of the pancreas. No flow in the fluid around the tail. Normal splenic vein. A partial splenic rupture was considered the most likely diagnosis. Because the patient was stable with minor symptoms, we advised a control examination the follo
The patient was examined two days later because the surgeon had found him hemodynamically stable and had still minor symptoms. The pancreas is now surrounded by fluid and at the site of the irregularity in the contour, there is now a defect filled with fl
The patient was examined two days later because the surgeon had found him hemodynamically stable and had still minor symptoms. The pancreas is now surrounded by fluid and at the site of the irregularity in the contour, there is now a defect filled with fl
Transverse image of the pancreatic rupture
Transverse image of the pancreatic rupture
videoclip shows the rupture of the pancreas
videoclip of the fluid collection around the pncreas 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
There is now a larger fluid collection around the pancreatic tail. Longitudinal view
There is now a larger fluid collection around the pancreatic tail. Longitudinal view
videoclip shows the fluid collection
A CT scan showed the same findings. An ultrasound guided percutaneous drainage procedure of the fluid collections was performed
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 some time later after percutaneous drainage of the fluid collections and conservative treatment. The effusions are gone
Pancreas some time later after percutaneous drainage of the fluid collections and conservative treatment. The effusions are gone
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 site of the rupture
The pancreatic duct in the distal part of the pancreas can be followed to the site of the rupture
The fluid collection between the pancreatic tail and the spleen is gone
The fluid collection between the pancreatic tail and the spleen 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

Created with

  • Hitachi Ultrasound System