A Case of Type IIIb Pancreatic Trauma in which Pancreatic Resection was Avoided by Endoscopic Pancreatic Stenting and Intraperitoneal Drainage

Abstract

A 29-year-old man was admitted to our hospital after suffering a blunt abdominal injury from a steering-wheel in a car accident. A CT scan revealed injury to the head of the pancreats. No other serious organ injury was seen, and his vital signs were stable. Therefore, he was treated conservatively. On the third day, the serum amylase level was elevated, and follow-up CT showed increased ascites. Endoscopic retrograde pancreatography (ERP) showed contrast media leakage from the main pancreatic duct. Since the upstream duct was also contrasted, an endoscopic nasopancreatic drainage (ENPD) tube was placed to cross the injured site. Subsequently, intraperitoneal drainage around the pancreatic head and enterostomy for enteral nutrition were instituted. ERP on the 32nd day showed disappearance of the leakage, but revealed a stricture of the main pancreatic duct at the injury site. An endoscopic retrograde pancreatic drainage (ERPD) tube was placed instead of the ENPD tube. On ERP on the 149th day, the stricture remained without secondary upstream ductal dilation, and the ERPD tube was removed. Placement of an endoscopic pancreatic stent can be one option in the treatment of selected patients with type IIIb pancreatic trauma.