Clinical Case Database / Category: Patient Management

Blunt pancreatic trauma: an easily missed diagnosis in a young adult patient

Publication details

MT Roach, MA Rathore, G Singh-Ranger, Dr Syed S Nasir
Foundation Years Journal, volume 9, issue 2, p.50 (123Doc Education, London, February 2015)


This case describes an acute presentation of a young patient with severe blunt abdominal trauma. However, because of her young age and massive physiological reserves, she was able to mask the severity of her signs and symptoms during a thorough physical examination. This resulted in the diagnosis of her pancreatic trauma being initially missed. It was her second presentation to the emergency department, two days later, when the severity of her symptoms and signs mandated an urgent CT scan. This showed a grade III pancreatic and liver trauma. She was managed conservatively at a hepatobiliary tertiary centre, with repeated imaging to check for any complications. She made a good recovery with conservative management.

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MT Roach

CT3 Emergency Medicine, North Tyneside General
Hospital, Rake Lane, North Shields, NE29 8NH.

MA Rathore

Consultant General Surgeon, Department of Surgery,
Boston Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9QS.

G Singh-Ranger

Consultant General Surgeon, Department of Surgery, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent, CT1 3NG.

Dr Syed S Nasir (Corresponding author)

Locum Speciality Registrar, Mid Staffordshire NHS Foundation Trust, Stafford Hospital, Weston Road, Stafford, ST16 3SA.


1. Cirillo RL, Koniaris LG. Detecting blunt pancreatic injuries. J Gastrointest Surg. 2002;6:587–598.
2. Debi U, Kaur R, Prasad KK, Sinha SK, Sinha A, and Singh K Pancreatic trauma: A concise review World
J Gastroenterol. Dec 21, 2013; 19(47): 9003–9011.
3. Sutherland I, Ledder O, Crameri J, Nydegger A, Catto-Smith A, Cain T, Oliver M. Pancreatic trauma in children. Pediatr Surg Int. 2010 Dec; 26(12):1201-6.
4. Cigdem MK, Senturk S, Onen A, Siga M, Akay H, Otcu S. Nonoperative management of pancreatic injuries in pediatric patients. Surg Today. 2011 May;41(5):655-9. Epub 2011 May 1.
5. E L Bradley, 3rd, P R Young, Jr, M C Chang, J E Allen, C C Baker, W Meredith, L Reed, and M Thomason Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg. Jun 1998; 227(6): 861–869.
6. Fisher M, Brasel K. Review Evolving management of pancreatic injury. Curr Opin Crit Care. 2011 Dec; 17(6):613-7.
7. Krige JE, Kotze UK, Hameed M, Nicol AJ, Navsaria PH Pancreatic injuries after blunt abdominal trauma: an analysis of 110 patients treated at a level 1 trauma centre S Afr J Surg. 2011 Apr;49(2):58, 60, 62-4 passim.
8. Moore EE, Cogbill TH, Malangoni MA et al. Organ injury scaling II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma 30: 1990. 1427–1429
9. Herman R, Guire KE, Burd RS, Mooney DP, Ehlrich PF. Utility of amylase and lipase as predictors of grade of injury or outcomes in pediatric patients with pancreatic trauma. J Pediatr Surg. 2011 May;46(5):923-6.
10. Jobst MA, Canty TG Sr, Lynch FP. Management of pancreatic injury in pediatric blunt abdominal trauma. J Pediatr Surg. 1999 May;34(5):818-23; discussion 823-4.
11. Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. The Lancet, Volume 373, Issue 9673, Pages 1455 - 1461, 25 April 2009.
12. Song Q, Tang J, Lv FQ, Zhang Y, Jiao ZY, Liu Q, Luo YK. Evaluation of blunt pancreatic injury with contrast-enhanced ultrasonography in comparison with contrast-enhanced computed tomography. Exp Ther Med. 2013 May;5(5):1461-1465.
13. Panda A, Kumar A, Gamanagatti S, Bhalla AS, Sharma R, Kumar S, Mishra B. Evaluation of diagnostic utility of multidetector computed tomography and magnetic resonance imaging in blunt pancreatic trauma: a prospective study. Acta Radiol. 2014 Apr 23. pii: 0284185114529949. [Epub ahead of print].


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