Pediatric Pancreatic Trauma

  • Etiology: Blunt abdominal trauma caused by handlebar injury or non-accidental trauma
  • Imaging CT:
    — Spectrum is contusion (pancreatic enlargement) to laceration to fracture to transection
    — Transection is difficult to identify: look for hypodense line in pancreas with surrounding inflammation
    — Best indicators for injury is fluid in lesser sac or anterior pararenal space or anterior to the portal vein
    — Peripancreatic fluid collection or pseudocyst
    — Findings of focal areas of decreased enhancement can be subtle or absent initially
    — Look for associated duodenal injury
  • Note: Absence of peripancreatic fluid does not exclude pancreatic trauma
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:
    — Most common cause of pancreatitis in children
    — Pancreatic transaction more common in children due to relative large size of pancreas and weak abdominal muscles

Radiology Cases of Pancreatic Trauma

Radiology Cases of Incorrect CT Technique Without the Use of Intravenous Contrast for the Assessment of Blunt Abdominal Trauma

CT without intravenous contrast using incorrect technique for the assessment of blunt abdominal trauma
Axial CT without contrast of the abdomen shows grossly unremarkable unenhanced solid organs of the abdomen without free air or free fluid.

Radiology Cases of Pancreatic Trauma Causing Pancreatitis

CT and US of pancreatic trauma / traumatic pancreatitis
Axial CT with contrast of the abdomen (above) shows an enlarged pancreatic head with some mild intrahepatic biliary dilation and non-visualization of the common bile duct. Transverse US of the pancreas obtained a day later (below) shows an enlarged hypoechoic pancreatic head.

Radiology Cases of Pancreatic Trauma Causing Pancreatic Contusion

CT of contusion of pancreas
Axial CT with contrast of the abdomen shows a heterogenous appearance to the pancreatic head (middle left and below left) which is also appreciated on the coronal image (above right) just medial to the contrast filled duodenum. There was a large amount of free fluid in the pelvis (below right)

Radiology Cases of Pancreatic Trauma Causing Pancreatic Transection

CT of pancreatic trauma / pancreatic laceration
Axial CT with contrast of the abdomen shows a linear low density just anterior to the portal vein at the junction of the pancreatic head and pancreatic body. There is a large amount of peripancreatic fluid.
CT of pancreatic transection
Axial CT with contrast of the abdomen (above) shows a near-complete transection of the pancreatic body along with a large amount of free fluid deep in the pelvis (below)

Radiology Cases of Pancreatic Trauma Causing Pancreatic Pseudocyst

CT of traumatic pancreatic pseudocyst
Axial CT with contrast of the abdomen shows a low density fluid-filled structure just to the left of midline and posterior to the body of the pancreas.