Successful treatment of grade III traumatic pancreatic injury with non-operative management: a case report.

Abstract

According to the American Association for the Surgery of Trauma, distal pancreatectomy or pancreatic duct drainage is recommended for grade III traumatic pancreatic injuries. We report a case of traumatic pancreatic injury involving the main pancreatic duct in which this method failed to drain fluid from the area distal to the injury site. A 19-year-old woman presented with a bruised upper left abdomen after a bicycle fall. Computed tomography revealed a linear area of poor contrast in the pancreatic body, leading to the diagnosis of grade III pancreatic injury. Endoscopic retrograde pancreatography revealed damage to the pancreatic duct, prompting endoscopic pancreatic stent placement. We added abdominal cavity drainage, peritoneal lavage, and endoscopic ultrasound-guided transgastric pseudocyst drainage. In the patient with pancreatic duct injury, drainage distal to the injury site was unattainable with a pancreatic duct stent; therefore, alternative drainage sites were utilized, thereby obviating the need for surgery.