A Case of Type IIIb Pancreatic Trauma in which Surgery Could be Avoided by Pancreatic Drainage

Abstract

A 60-year-old man who developed a bruise in the upper abdomen after he fell against an iron fence was admitted to our hospital. Abdominal CT scan showed injury of the head of the pancreas. Endoscopic retrograde pancreatography (ERP) showed no contrast medium leakage from the main pancreatic duct. We selected conservative treatment with an endoscopic nasopancreatic drainage (ENPD) tube placed in the main pancreatic duct. ENPD contrast examination on the second day showed contrast medium leakage from the main pancreatic duct at the pancreatic head. We diagnosed type IIIb pancreatic trauma, however, continued conservative treatment as the general condition of the patient was improving. The ENPD was exchanged for an endoscopic retrograde pancreatic drainage (ERPD) tube on the 25th day. The patient was discharged on the 36th day with the ERPD tube in place. The ERPD tube was removed after three months from the injury. A medical follow-up at 13 months revealed disappearance and absence of recurrence of the bruise.
Surgical treatment may be avoided in some case with type IIIb pancreatic trauma by instituting pancreatic drainage. It is necessary to accumulate further evidence to establish a standard therapeutic strategy for type IIIb pancreatic trauma.