Traumatic pancreatitis

• Published in: Abdominal imaging 2020-05, Vol.45 (5), p.1265-1276
• Main Authors: Sharbidre, Kedar G., Galgano, Samuel J., Morgan, Desiree E.
• Format: Article
• Language: English
• Subjects: Abdominal Injuries - complications; Abdominal Injuries - diagnostic imaging; Anastomosis; Biomarkers; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Complications; Diagnosis; Early Diagnosis; Fibrosis; Fistula; Fistulae; Gastroenterology; Hepatology; Humans; Imaging; Injuries; Medical imaging; Medicine; Medicine & Public Health; Morbidity; Pancreas; Pancreas - injuries; Pancreatitis; Pancreatitis - diagnostic imaging; Pancreatitis - etiology; Patients; Perforation; Postoperative Complications - diagnostic imaging; Radiology; Special Section: Pancreatitis; Steatosis; Stricture; Surgery; System effectiveness; Trauma
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-019-02241-7

Post-traumatic pancreatitis can develop secondary to blunt or penetrating abdominal trauma, post-endoscopic retrograde cholangiopancreatography, or following pancreatic surgery. Clinical findings are often nonspecific, and imaging findings can be subtle on presentation. Early diagnosis of pancreatic duct injury is critical and informs management strategy; imaging plays important role in diagnosis of ductal injury and identification of delayed complications such as retroperitoneal fluid collections, pancreatic fistula, ductal strictures, and recurrent pancreatitis. Delayed diagnosis of pancreatic injury is associated with high mortality and morbidity, and therefore, heightened clinical suspicion is important in order for the radiologist to effectively impact patient care. There are accepted scoring systems for classification of post-traumatic pancreatic injuries and these should be included in radiology reports. Pancreatitis following ERCP appears similar on imaging to other causes of acute pancreatitis unless concomitant perforation occurs. Postoperative pancreatitis may be difficult to diagnose given associated or overlapping expected postoperative findings. Postoperative pancreatic fistulas typically arise from either a leaking pancreatic resection surface or the pancreatoenteric anastomosis and are more common in patients with a “soft” pancreas. Preoperative imaging biomarkers like duct diameter, pancreatic glandular steatosis and parenchymal fibrosis can help predict risk of development of postoperative pancreatic fistula. This review will illustrate the imaging features and the most important imaging findings in patients with post-traumatic pancreatitis.