A Case of Traumatic Pancreatic Injury Associated with Main Pancreatic Duct Injury That Improved with Endoscopic Treatment

Abstract

The patient was a 53-year-old male, who was transported to our hospital with the chief complaint of abdominal pain since falling down. On abdominal dynamic CT, the tail of the pancreas showed poor contrast effect and a hematoma was discovered expanding into the surrounding area; the findings were deemed to suggest pancreatic injury associated with main pancreatic duct injury. Surgical treatment was recommended, but refused, therefore, the patient was treated conservatively. On the 10th day of illness, the main pancreatic duct was found to become obfuscated in the tail area on MRP, and CT revealed two cystic lesions in the tail of the pancreas. Fever and abdominal pain set in from the 12th day of illness, and CT revealed a swollen pancreatic cyst on the 16th day of illness, which was thought to represent pancreatic pseudocyst formation. After the limit of conservative treatment was reached, endoscopic drainage was carried out to secure a field of view at the time of surgery. In the endoscopic retrograde pancreatography (ERP) carried out on the 17th day of illness, the pancreatic tail could not be visualized. Successful drainage was accomplished by transnasal introduction of a pig-tail catheter into the cyst, and the cyst was eradicated. The tube was changed to a pancreatic duct stent on the 66th day of illness. There was no recurrence of abdominal pain or of the cyst formation, the patient recovered satisfactorily, and was discharged from the hospital on the 70th day. Stenting is a low-invasive and effective treatment strategy for pancreatic duct injury, however, since its applicability is still not yet very well defined, further accumulation of cases is necessary.