Pancreatic trauma: A concise review

Table 1 Computed tomographic signs of pancreatic injury

Specific signs	Fracture of the pancreas
	Pancreatic laceration
	Focal or diffuse pancreatic enlargement/edema
	Pancreatic hematoma
	Active bleeding/extravasation of intravenous contrast
	Fluid separating the splenic vein from posterior aspect of pancreas
Non-specific signs	Inflammatory changes in peripancreatic fat and mesentery
	Fluid surrounding the superior mesenteric artery
	Thickening of the left anterior renal fascia
	Pancreatic ductal dilatation
	Acute pseudocyst formation/peripancreatic fluid collection
	Fluid in the anterior and posterior pararenal spaces
	Fluid in transverse mesocolon and lesser sac
	Hemorrhage into peripancreatic fat, mesocolon and mesentery
	Extraperitoneal fluid
	Intraperitoneal fluid

Table 2 Computed tomographic grading of blunt pancreatic injuries

CT grading	CT findings of blunt pancreatic injury
Grade A	Pancreatitis and/or superficial lacerations at any site
Grade B
BI	Deep laceration at distal pancreas
BII	Transections at distal pancreas
Grade C
CI	Deep lacerations at proximal pancreas
CII	Transections at proximal pancreas

Reproduced from Wong et al[32]. CT: Computed tomography.

Table 3 Classification of pancreatic injuries by endoscopic retrograde cholangiopancreatography

Grade	Description
I	Normal main pancreatic duct on ERCP
IIa	Injury to branches of main pancreatic duct on ERCP with contrast extravasation inside the parenchyma
IIb	Injury to branches of main pancreatic duct on ERCP with contrast extravasation into the retroperitoneal space
IIIa	Injury to the main pancreatic duct on ERCP at the body or tail of the pancreas
IIIb	Injury to the main pancreatic duct on ERCP at the head the pancreas

Reproduced from Takishima et al[38]. ERCP: Endoscopic retrograde cholangiopancreatography.

Table 4 American Association for the surgery of trauma classification of pancreatic trauma

Grade	Injury	Description
I	Hematoma	Minor contusion without ductal injury
	Laceration	Superficial laceration without ductal injury
II	Hematoma	Major contusion without ductal injury or tissue loss
	Laceration	Major laceration without ductal injury or tissue loss
III	Laceration	Distal transection or pancreatic parenchymal injury with ductal injury
IV	Laceration	Proximal transection or pancreatic parenchymal injury involving the ampulla
V	Laceration	Massive disruption of the pancreatic head

Reproduced from Campbell et al[42].