The pancreatic lesion is a very infrequent finding after a closed abdominal tramautism with a rate of complications that affects 30-40% of patients and mortality that could rteach 39%. 1-4 It is considered that only around 5% of closed abdominal traumatisms affect the pancreatic gland.1 The disgnostic suspicion is noramlyy late due to the unspecificity of the clinical symptoms.5 The computerised tomography (CT), with some limitations, is the imaging test of choice in the diagnosis and cáncer staging in the acute phase..6 The complete section of the Wirsung conduct, which occurs in 15-30%, is an indication of urgent surgical treatment.1,2 According to our experience, the closed ...view middle of the document...
During the operation the complete section at the level of the pancreatic istmus was confioremed on accessing the retroperitmneum, and, after checking the viability of the pancreatic tiissue a proximal closure with mechanical suture, distal pancreatogastrotomy on gastric posterior face and the placement of intraabdominal drainage.
The hospital evloution is satisfactory, with the beginning of oral tolernace and the withdrawal of drainage after ruling out postoperative pancreatic fistula (FPPO) from the thirs postoperative day. ASfter one and a half years of follow up and punctual episodes of unspecific abdomibnal pain the patient is now asymptomatic.
Female of 16 years with no clinical background of interest came to the ER of Hospital Insular de Menorca after a closed abdminal traumatism cauysed by a horse kick. On physical examination the patient was awake, with vital signs within the ranges of normality, epigastric abdominal pain with no significant signs of peritoneal and amylasemia irritation. Suspecting intraabdominal lesion with pancreatic gland compromise, a CT scan was performed with unspecific report and abdominal MRI where a complete pancreatic fracture was observed at the level of the corpocaudal union. In the light of those findings it was decided to urgently transfer the patient to our hospital as it was the reference centre. During the exploratory laparaotomy the radiological findings were cionfirmed (Figura 2) and a closure of the cephalic pancreatic portion was prcatised with irreabsoirbablke monofilasr suture and posterior pancreatogastrotomy of the corpocaudal sector. On the 3rd day after the operation FPPO type A de bajo debito presented, which was handled in a conservative manner. On the 5th day after the operation she had gas expulsion and on the 10th day she began to be able to eat orally, repectively. After ruling out complications and checking the analytical and radiological resolutions of the FPPO thye drainage was removed on the 13th day after the operation. The patient was discharged on the 17th day after the operation and currently ( seven months after the operation) she is asymptomatic.
Abdominal traumatisms of high energy such as those due to horse-riding accidents can provoke the transection of the pancreatic gland by crushing of the retroperitoneal structures against the spinal column.8,9 The most affected región is the neck in 37% of the cases given the anatomical characteristics of location and mor`hology, followed by the body and tale in 36% and 26%, respectively. 4,6 The lesion isolated isolated from the gland is not very frequent and is generally associtaed with other intraabdominal lesions.4 In our setting, a traditional type of horse-riding forms part of popular culture. We have observed that this type of practice is associated with closed abdominal trauamtisms where the pancreatic gland can be affected.7 the retroperitoneal location of the páncreas conditions that the signs...