AMHSR

Distal Pancreatectomy Secondary to a Blunt Trauma Following a Road Traffic Accident (RTA) - A Case Report

Author(s): Akram Rajput, Syed Mohammad Mazhar Uddin, Aatera Haq, Zeeshan Zafar and Uzair Yaqoob*

Background: Pancreas being a horizontally placed organ in the abdomen extends from concavity of the second part of duodenum to the hilus of spleen. Since it is largely retroperitoneal, there is only some degree of movement that makes it susceptible to blunt trauma. This rate of trauma is increasing and is more disastrous when it involves the ducts. Case Report: A 19-year-old male with no known comorbid presented to the emergency department after a road traffic accident involving a Motorcycle and truck, with him being run over by the truck. Abdomen was tense, tender to touch, guarding and rebound tenderness was positive. His baselines were all normal except Hb 11.7 g/dl, TLC 12.7 × 109, total bilirubin 8.8 mg/dl and alkaline phosphatase 348 IU/L. Ultrasound showed an iso-echoic area measuring 1.8 × 0.8 cm, seen adjacent to the right kidney, suggestive of sub capsular hematoma. Free fluid streak in Morrison’s pouch and minimal peri-splenic free fluid was also noted. Furthermore, CT scan showed a retroperitoneal zone 1 hematoma behind the pancreas. We immediately prepared the patient for an exploratory laparotomy. According to the classification of pancreatic injury, our patient was classified as class 2. Post-operatively the patient did well with ultrasound and CT scan done 2 weeks after the procedure showing no collection around the pancreas and intact spleen. Conclusion: Distal pancreatectomy with splenic salvage, together with sufficient drainage of the retro peritoneum, adequate bowel rest and hyper alimentation is integral in the management of transection injury to the pancreas.


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