Percutaneous drainage for isolated pancreatic injury: A minimally invasive solution

Abstract

Pinar Yazici, Rahsan Gocmen, Fatih Yuzbasioglu

Isolated traumatic rupture of the pancreas is an uncommon presentation with a rate of less than 5% of cases of major abdominal trauma. The proper management of peripancreatic fluid collections following pancreatic trauma is still uncertain. We present a patient with isolated pancreatic injury that was managed with percutaneous drainage. A 22-year-old male patient, who had fallen from a tree 3 days previously, was admitted to our clinic with symptoms of vomiting and abdominal distention. Laboratory results demonstrated leucocytosis (20.100/mm3 ) and elevated amylase levels (754 IU/L, n = 25-100 IU/L). Radiological diagnosis of a pancreatic injury associated with multiple peripancreatic fluid collections (the largest with a diameter of 100 mm × 40 mm × 75 mm) was established using ultrasonography (US). Computed tomography (CT) confirmed pancreatic transection. Conservative treatment, including somatostatin, was administrated and 5 days later percutaneous drainage catheters were placed under US guidance due to enlargement of the cystic collections (170 mm × 85 mm × 65 mm) and clinical progression. Seventeen days later, after confirming the regression of the fluid collections by US, the catheters were removed. No morbidity was observed and the control CT was normal. In hemodynamically stable patients, the percutaneous drainage procedure is one of the easiest and simplest ways to treat posttraumatic pancreatic fluid collections with less morbidity