TITLE

Efficacy of Computed Tomography in the Diagnosis of Pancreatic Injury in Adult Blunt Trauma Patients: A Single-Institutional Study

AUTHOR(S)
Ilahi, Obeid; Bochicchio, Grant V.; Scalea, Thomas M.
PUB. DATE
August 2002
SOURCE
American Surgeon;Aug2002, Vol. 68 Issue 8, p704
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Blunt trauma to the pancreas is an uncommon injury, which can be difficult to diagnose. Most studies are multi-institutional, include both helical and axial CT, and report sensitivities of 40 to 67 per cent. We evaluated the efficacy of spiral CT for the diagnosis of blunt pancreatic injury in a single large-volume institution. We retrospectively reviewed 22,000 blunt trauma patients seen between 1996 and 2000. Pancreatic injury was identified in 40 patients (0.2%). All patients evaluated with spiral CT were given both oral and intravenous contrast. A total of 40 blunt pancreatic injuries were identified. The mean age was 35 years. Seventy-five per cent were male. Mean Injury Severity Scale score was 29 and overall mortality 12.5 per cent. Thirty-one patients (78%) underwent laparotomy. Twelve patients went directly to the operating room for urgent exploration and 19 had a preoperative CT. CT was positive for pancreatic injury in 13 patients (sensitivity 68%). All 13 patients had confirmed pancreatic injury at the time of surgery positive predictive value =100%). Using the American Association for the Surgery of Trauma grading system operative findings and CT correlated in 68 per cent of those patients who had both CT and laparotomy. CT underestimated pancreatic injury in the remaining 31 per cent. Nine patients were managed nonoperatively without complication, and six had pancreatic injury on CT. The other three had a negative CT but had clinical and laboratory evidence of pancreatic injury. Overall CT scan was 68 per cent (19 of 28) accurate in diagnosing pancreatic injury. We conclude that CT scan is only moderately sensitive and can underestimate or miss pancreatic injury. Although CT moderately correlated with injury grade it was highly predictive for presence of injury. The new multidetector helical scanner may improve our diagnostic ability.
ACCESSION #
7743249

 

Related Articles

  • Blunt pancreatic trauma: evaluation with MDCT technology. Gordon, Robert; Anderson, Stephan; Ozonoff, Al; Rekhi, Satinder; Soto, Jorge // Emergency Radiology;Aug2013, Vol. 20 Issue 4, p259 

    The purpose of this paper is to determine the relative frequency of multi-detector CT (MDCT) findings of pancreatic injury in blunt trauma and to determine their diagnostic accuracy in predicting main pancreatic duct injury. Fifty-three patients (31 male, 22 female; mean 44.1 years) with blunt...

  • The efficacy of four-slice helical CT in evaluating pancreatic trauma: a single institution experience. Wei-Jing Lee; Ning-Ping Foo; Hung-Jung Lin; Yen-Chang Huang; Kuo-Tai Chen // Journal of Trauma Management & Outcomes;2011, Vol. 5 Issue 1, p1 

    Study objective: To assess the efficacy of computed tomography (CT) in evaluating patients with pancreatic trauma. Methods: We undertook a retrospective review of all blunt trauma patients admitted to the Chi-Mei Medical Center from January 2004 to June 2006. Every patients underwent abdominal...

  • Management of blunt pancreatic trauma: what's new? Potoka, D.; Gaines, B.; Leppäniemi, A.; Peitzman, A. // European Journal of Trauma & Emergency Surgery;Jun2015, Vol. 41 Issue 3, p239 

    Pancreatic injuries are relatively uncommon but present a major challenge to the surgeon in terms of both diagnosis and management. Pancreatic injuries are associated with significant mortality, primarily due to associated injuries, and pancreas-specific morbidity, especially in cases of delayed...

  • Pancreatic injuries from blunt trauma. Craig, Mark H.; Talton, David S. // American Surgeon;Feb1995, Vol. 61 Issue 2, p125 

    Reviews cases of pancreatic injuries from blunt trauma. Compression of the pancreas against the vertebral bodies as the classic description of the mechanism of blunt trauma to the pancreas; Management of blunt injuries by localized resection and/or drainage; Absence of relation between blunt...

  • Pancreatic Trauma: Demographics, Diagnosis, and Management. STAWICKI, STANISLAW PETER; SCHWAB, C. WILLIAM // American Surgeon;Dec2008, Vol. 74 Issue 12, p1133 

    Pancreatic injuries are rare, with penetrating mechanisms being causative in majority of cases. They can create major diagnostic and therapeutic challenges and require multiple diagnostic modalities, including multislice high-definition computed tomography, magnetic resonance...

  • Pancreatic transection due to blunt trauma. Ankouz, Amal; Elbouhadouti, Hicham; Lamrani, Jihane; Taleb, Khalid Ait; Louchi, Abdelatif // Journal of Emergencies, Trauma & Shock;Jan2010, Vol. 3 Issue 1, p76 

    Blunt fractures of the pancreas are rare and serious lesions. An isolated injury to the pancreas is uncommon. Physical signs and laboratory parameters are often inaccurate, and missing the diagnosis can cause serious clinical problems. We report a case of a 28-year-old woman with blunt...

  • Detecting Blunt Pancreatic Injuries Cirillo Jr., Robert L.; Koniaris, Leonidas G.; Cirillo, Robert L Jr // Journal of Gastrointestinal Surgery;Jul2002, Vol. 6 Issue 4, p587 

    Pancreatic injury after blunt abdominal trauma is exceedingly uncommon, occurring in less than 5% of major abdominal injuries. When blunt pancreatic injury does occur, however, it is notoriously difficult to identify. The use of serum amylase has been advocated in the diagnosis of such injury,...

  • Complete pancreatic transection associated with splenic injury resulting from blunt trauma. Singh, Kumkum; Singh, Amit; Vidyarthi, Shivaji H.; Garg, Manish // Indian Journal of Medical Specialities;Jan-Jun2014, Vol. 5 Issue 1, p1 

    Injury to the pancreas after blunt abdominal trauma is less frequent than that of other solid organs. The clinical presentation can be subtle resulting in delayed treatment with high morbidity and mortality. A seventeen years male presented with pain jaw and abdomen following fall from tree. He...

  • 'Management of blunt renal injury: what is new?'. Kautza, B.; Zuckerbraun, B.; Peitzman, A. // European Journal of Trauma & Emergency Surgery;Jun2015, Vol. 41 Issue 3, p251 

    The diagnosis, workup and management of blunt renal injury have evolved greatly over the past decades. Evaluation and management of blunt renal injury echoes the increasing success of nonoperative management in other blunt abdominal solid organ injury, such as liver and spleen. Decision-making...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics