The pancreas is located behind the stomach. The wider, right-sided head is lies in the curve of the duodenum, the first part of the small intestine. The tapered left side or body of the pancreas ends in the tail which lies near the spleen under the left side of the ribcage.
The pancreas produces enzymes and hormones. The enzymes, including amylase, primarily digest fat and are delivered via the pancreatic duct through the ampulla of Vater into the duodenum. The hormones insulin and glucagon are released into the bloodstream and primarily regulate the tissue storage and release of glucose into the blood.
Injury to the pancreas occurs less frequently than injury to the spleen, liver and kidney, and is usually part of multi-organ injury.
Traumatic injury to the pancreas is relatively uncommon. Although blunt abdominal trauma occurs more frequently, pancreatic injury is more than five times as common when the abdominal injury is penetrating1.
The pancreas is seldom injured alone. Usually two or three other organs are also injured, typically the stomach and liver rather than the spleen or kidney1.
Practice PointPancreatic injury may be missed because it is relatively uncommon and usually associated with injury to other abdominal organs |
Serial Computed Tomography (CT) and serum amylase are required to exclude pancreatic injury after blunt trauma.
Unless brisk bleeding requires emergency exploratory surgery, Computed Tomography (CT) is the standard method of evaluating blunt trauma to the pancreas. CT evidence of blood or other fluid around the pancreas warrants thorough investigation, but this has proved a fairly insensitive method of detecting pancreatic injury2. Not only are a significant proportion of cases missed, but the severity of the injury is underestimated.
Unlike pancreatitis, trauma does not reliably cause an initial rise in blood-levels of the enzyme amylase3. However, rising or persistently raised serum amylase levels are more reliable indicators4.
Thus, for both CT and serum amylase, serial investigations may be required.
Practice PointIn missed diagnosis of pancreatic injury, look for serial abdominal CT and serum amylase investigations |
Death is usually from associated injuries.
Severity is categorised by the Pancreas Injury Scale.
Mortality following pancreatic injury is around 20%, the majority dying in the first 24-48 hours5.
Practice PointMissed pancreatic injury may contribute to avoidable death from blunt abdominal injury |
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