Healey Andrew J, Dimarakis Iannis, Pai Madhava, Jiao Long R
HPB Surgery, Division of Surgery, Oncology, Reproductive Biology and Anesthetics, Imperial College of Science, Technology and Medicine, Hammersmith Hospital Campus, London, UK.
Case Rep Gastroenterol. 2008 Jan 29;2(1):22-6. doi: 10.1159/000112919.
Blunt abdominal trauma is a rare but well-recognized cause of pancreatic transection. A delayed presentation of pancreatic fracture following sport-related blunt trauma with the coexisting diagnostic pitfalls is presented.
A 17-year-old rugby player was referred to our specialist unit after having been diagnosed with traumatic pancreatic transection, having presented 24 h after a sporting injury. Despite haemodynamic stability, at laparotomy he was found to have a diffuse mesenteric hematoma involving the large and small bowel mesentery, extending down to the sigmoid colon from the splenic flexure, and a large retroperitoneal hematoma arising from the pancreas. The pancreas was completely severed with the superior border of the distal segment remaining attached to the splenic vein that was intact. A distal pancreatectomy with spleen preservation and evacuation of the retroperitoneal hematoma was performed.
DISCUSSION/CONCLUSION: Blunt pancreatic trauma is a serious condition. Diagnosis and treatment may often be delayed, which in turn may drastically increase morbidity and mortality. Diagnostic difficulties apply to both paraclinical and radiological diagnostic methods. A high index of suspicion should be maintained in such cases, with a multi-modality diagnostic approach and prompt surgical intervention as required.
钝性腹部创伤是胰腺横断的一种罕见但已被充分认识的病因。本文介绍了一例与运动相关的钝性创伤后胰腺骨折的延迟表现以及并存的诊断陷阱。
一名17岁的橄榄球运动员在运动损伤24小时后被诊断为创伤性胰腺横断，随后被转诊至我们的专科病房。尽管血流动力学稳定，但在剖腹手术中发现他有弥漫性肠系膜血肿，累及大小肠系膜，从脾曲向下延伸至乙状结肠，还有一个源于胰腺的巨大腹膜后血肿。胰腺完全横断，远端部分的上缘仍与完整的脾静脉相连。进行了保留脾脏的远端胰腺切除术并清除了腹膜后血肿。
讨论/结论：钝性胰腺创伤是一种严重的病症。诊断和治疗常常可能延迟，这反过来可能大幅增加发病率和死亡率。诊断困难适用于辅助临床和放射学诊断方法。在此类病例中应保持高度的怀疑指数，采用多模式诊断方法并根据需要及时进行手术干预。
