[Rupture of the pancreatic isthmus due to blunt abdominal trauma].

The authors report a case of a grade III pancreatic injury resulting from a blunt abdominal trauma, referred to our department for observation and treated with distal splenopancreatectomy. Pancreatic traumas account for approximately 3-5% of blunt abdominal injuries. In cases of isolated pancreatic injuries failure to recognise injury to the Wirsung duct is the main cause of morbidity and mortality. Spiral CT with contrast medium is the standard investigation in haemodynamically stable traumatised patients, with a sensitivity of approximately 90% in the most recent series. However, at least initially, the extent of the pancreatic damage is not proportional to the severity of the clinical and instrumental picture. The patients need to be continuously and carefully monitored and, in the case of suspected pancreatic injury, the imaging study should be repeated 12-24 hours after the trauma. In case of doubt, ERCP provides detailed information on the condition of the Wirsung duct and, in selected cases, may play a therapeutic role through the positioning of an intraductal prosthesis. The surgical management of blunt pancreatic trauma should be individualised depending on the site and severity of the injury, the interval elapsing after the trauma and the presence of associated injuries.