Diagram of the pancreas, showing its relation to the duodenum and the mesenteric veins and arteries Diagnosis The diagnosis of this form of injury can be challenging because of the pancreas' location inside the abdomen. The use of ultrasound can reveal fluid around the site of injury. Computed tomography (CT) can also be utilized as a non-invasive diagnostic tool, but its reliability is low; one retrospective case review found that computed tomography had either failed to find injuries or had underestimated the severity of injury in more than half of 17<unk>  patients. Serum amylase has also been shown to be of limited diagnostic utility within the first three hours following injury. Management of a<unk>  can be difficult because other abdominal organs, such as the liver, usually have sustained trauma as well. Several common symptoms manifest hours after the injury such as tachycardia, abdominal distension, and midepigastric tenderness. Indications for surgical intervention include: peritonitis based on physical examination; hypotension in combination with a positive focussed assessment with sonography (ultrasound) for trauma (FAST); and pancreatic duct disruption based on the results of thin-cut computed tomography or endoscopic retrograde cholangiopancreatography (ERCP). Commonly, a laparotomy is done in order to directly visualize the injury, and generally this approach is the most accurate diagnostic method. Classification 1: Head of pancreas2: Uncinate process of pancreas3: Pancreatic notch4: Body of pancreas5: Anterior surface of pancreas6: Inferior surface of pancreas7: Superior margin of pancreas8: Anterior margin of pancreas9: Inferior margin of pancreas10: Omental tuber11: Tail of pancreas12: Duodenum<unk> es are classified according to the criteria of the American Association for the Surgery of Trauma (AAST). The grade of the trauma should be increased by one level for multiple injuries to the same organ. The description of the injury is that "based on most accurate assessment at autopsy, laparotomy, or radiological study." The pancreatic organ injury scale, as minimally modified, is: + The<unk>  Scale classification Grade Subcapsular hematoma Laceration I Minor contusion without ductal injury Superficial laceration without ductal injury II Major contusion without duct injury or tissue loss Major laceration without duct injury or tissue loss III Distal transection or parenchymal injury with duct injury IV Proximal transection or parenchymal injury, involving ampulla V Laceration-Massive disruption of pancreatic head Surgical treatment When there is no pancreatic duct injury, typically hemostasis and surgical drainage are the main form of treatment. Surgical repair is undertaken when there is evidence or suspicion of ductal injury. The type of surgery depends on the degree of the injury and its proximity to the mesenteric blood vessels that serve the pancreas. When injuries are not close to the mesenteric vessels, a distal pancreatectomy may be done; this procedure preserves much of the pancreas and usually avoids loss of its endocrine and exocrine functions. In severe cases of pancreaticoduodenal injury, a pancreaticoduodenectomy can be used. Common complications after surgery include pancreatitis, pancreatic fistula, abscess, and pseudocyst formation. Initial management of hemorrhage includes controlling it by packing the wound.
Pancreatic injury
Splenic injury
Blunt splenic trauma
Intestinal ischemia
Organ perforation
Biliary injury
Pancreatic fistula
Enterocutaneous fistula