Pancreatic Disorders & Therapy
Open Access

Abstract

Successful Conservative Management of Traumatic Pancreatic Duct Injury: A Case Report and Clinical Update

Ana Rita Oliveira Ferreira*, Daniela Martins, Carolina Tavares, Hugo Louro, Wilson Malta, Alexandre Costa, Miguel Mendes, Jorge Santos, Bela Pereira and Manuel Oliveira

Introduction: Pancreatic trauma without injuries to other organs is uncommon and the integrity of the main pancreatic duct is the critical factor in the management and outcome of these patients. Severe injuries or hemodynamic instability require emergent surgical intervention. In contrast, conservative strategy demands close monitoring and regular reassessment to detect any deterioration or complications that may need a change in the treatment plan. We present a case of a grade III pancreatic trauma in a stable and very young patient, successfully treated conservatively.

Case presentation: A 25-year-old male patient presented to the emergency department in context of thoracic and abdominal trauma, due to blunt trauma caused by machine compression. Patient’s symptoms were not severe. On physical examination, his vital signs were within normal limits, with complains of upper quadrants pain but no peritoneal signs. Computed tomography scan showed a complete laceration of the proximal region of the head of the pancreas, with minimal free fluid. Conservative treatment was decided. Magnetic resonance cholangiopancreatography was also performed, revealing two pancreatic fractures with an imperceptible Wirsung duct in practically the entire pancreas, probably collapsed, calling into question the hypothesis of sectioning. Between fractures, there is a segment of necrotic pancreas. The patient remained asymptomatic, with favourable laboratory and imaging evolution. After 5 months, magnetic resonance cholangiopancreatography showed a scar in the body of the pancreas, with no collections.

Conclusions: Non-operative approach plays an important role in the conduct of pancreatic trauma, aiming to preserve function while minimizing the risks associated with surgical interventions.

Published Date: 2024-12-02; Received Date: 2024-11-01