Rougé-Maillart C, Tracqui A, Tortel M C, Pessaux P, Penneau M, Ludes B
Unity of Forensic Medicine, Emergency Department, University Hospital, Angers, France.
Int J Legal Med. 2001 Dec;115(3):162-4. doi: 10.1007/s004140100235.
The authors report on an fatal case of closed trauma of the pancreas in a context of violence. A 55-year-old man was found unconscious on the sidewalk and died a short time after being taken to the hospital. He had been hit with several punches to the face and abdomen 6 h before. The post-mortem examination showed numerous bruises over the whole body, a haemoperitoneum, a fissuration of the spleen and a massive peripancreatic haemorrhage associated with a complete dilaceration of the pancreas head. Histological examination of the pancreas revealed a massive necrosis associated with a subtotal disappearance of the acini, numerous sites of cytosteatonecrosis and a large haemorrhagic suffusion of the peripancreatic tissue. This case illustrates the possibilities of pancreatic injuries induced by blunt force aimed at the abdomen in a context of violence. Even if this occurs as an isolated injury it can result in rapid death because of the particular type of pancreatic fracture which is frequently involved. In postmortem situations, the pancreas should be systematically checked at necropsy and a histological examination should be carried out at the slightest doubt of a pancreatic lesion or suspicion of blunt force abdominal injuries.
作者报道了一例在暴力情况下发生的胰腺闭合性创伤致死病例。一名55岁男性被发现昏迷在人行道上，被送往医院后不久死亡。他在6小时前脸部和腹部遭到多次拳击。尸检显示全身多处瘀伤、腹腔积血、脾脏破裂以及胰腺周围大量出血，伴有胰头完全撕裂。胰腺组织学检查显示大量坏死，腺泡几乎完全消失，多处细胞脂肪坏死灶以及胰腺周围组织大量出血性渗出。该病例说明了在暴力情况下腹部受到钝器打击导致胰腺损伤的可能性。即使这种损伤是孤立发生的，由于经常涉及的特殊类型的胰腺骨折，也可能导致迅速死亡。在尸检情况下，应在尸检时系统检查胰腺，一旦对胰腺病变有丝毫怀疑或怀疑有钝器所致腹部损伤，就应进行组织学检查。
