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Pancreatic Trauma - Emergency Management

General Information

General InformationGeneral Information


  • Pancreatic injuries are uncommon but are associated with significant morbidity and mortality given the significant mechanism required to injure the pancreas
  • Diagnosing pancreatic injuries can be challenging due to the delayed onset of signs and symptoms and limitations of available diagnostic modalities
  • Early diagnosis is key for optimal management1


  • Pancreas is fixed and mostly retroperitoneal, except the tail
    • Head: adjacent to duodenum
    • Uncinate process: extends inferiorly from the head, superior to superior mesenteric vessels
    • Neck: narrow area demarcating head from body
    • Body: portion of pancreas behind stomach
    • Tail: adjacent to spleen in the splenorenal ligament
  • For both penetrating and blunt pancreatic injury, presence of main pancreatic ductal injury is the major determinant of morbidity1
  • Blood supply
    • Superior pancreaticoduodenal artery from gastroduodenal artery
    • Inferior pancreaticoduodenal artery from superior mesenteric artery
    • Pancreatic branches of the splenic artery


  • Large portion of pancreatic injuries (up to two-thirds) are due to penetrating trauma2
  • Blunt trauma classically occurs by the pancreas being crushed between the anterior abdominal wall and vertebral column
    • Examples: handlebar injuries in bike accidents, steering wheel injuries in motor vehicle collisions, or assaultive trauma to the epigastrium
    • More commonly body, then head, then tail


  • Pancreatic injuries occur in 1%-5% of blunt abdominal trauma and 12% of penetrating trauma3
  • Mortality for pancreatic injuries ranges from 9% to 34% but only 5% of pancreatic injuries are directly related to fatality4
  • Most are associated with concurrent organ injuries
    • Over 75% of penetrating pancreatic injuries are associated with major abdominal vascular injuries5
    • Blunt pancreatic injuries are also associated with solid organ and hollow viscus injuries



General references used

  1. Potoka DA, Gaines BA, Leppäniemi A, Peitzman AB. Management of blunt pancreatic trauma: what's new? Eur J Trauma Emerg Surg. 2015 Jun;41(3):239-50
  2. Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon WF Jr, Malangoni MA. Pancreatic trauma: a ten-year multi-institutional experience. Am Surg. 1997 Jul;63(7):598-604
  3. Fisher M, Brasel K. Evolving management of pancreatic injury. Curr Opin Crit Care. 2011 Dec;17(6):613-7
  4. Debi U, Kaur R, Prasad KK, Sinha SK, Sinha A, Singh K. Pancreatic trauma: a concise review. World J Gastroenterol. 2013 Dec 21;19(47):9003-11
  5. Cirillo RL Jr, Koniaris LG. Detecting blunt pancreatic injuries. J Gastrointest Surg. 2002 Jul-Aug;6(4):587-98
  6. Mahajan A, Kadavigere R, Sripathi S, Rodrigues GS, Rao VR, Koteshwar P. Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: a prospective study with systematic review. Injury. 2014 Sep;45(9):1384-93
  7. Phelan HA, Velmahos GC, Jurkovich GJ, et al. An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. J Trauma. 2009 Mar;66(3):641-6
  8. Garvey EM, Haakinson DJ, McOmber M, Notrica DM. Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center. J Pediatr Surg. 2015 Feb;50(2):335-8
  9. Kobayashi L, Costantini TW, Coimbra R. Hypovolemic shock resuscitation. Surg Clin North Am. 2012 Dec;92(6):1403-23
  10. Stahel PF, Smith WR, Moore EE. Current trends in resuscitation strategy for the multiply injured patient. Injury. 2009 Nov;40 Suppl 4:S27-35
  11. Degiannis E, Glapa M, Loukogeorgakis SP, Smith MD. Management of pancreatic trauma. Injury. 2008 Jan;39(1):21-9
  12. Wilson RH, Moorehead RJ. Current management of trauma to the pancreas. Br J Surg. 1991 Oct;78(10):1196-202
  13. Recinos G, DuBose JJ, Teixeira PG, Inaba K, Demetriades D. Local complications following pancreatic trauma. Injury. 2009 May;40(5):516-20

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T906326, Pancreatic Trauma - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from Registration and login required.

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