Pancreatic Trauma
- Pancreatic trauma refers to injury to pancreas. This can occur due to blunt trauma to upper abdomen or due to penetrating injury due to some sharp object. Pancreas has risk of injury as it has very little protection from ribcage.
- Car accident or physical assault are common causes of pancreatic trauma. Treatment depends on severity of injury.
- Normally, Pancreas has many important functions in body, like, control of blood sugar levels by hormones like insulin and glucagon, making digestive juices for digestion of fats, proteins and carbohydrates, etc.
What can happen if Pancreas is injured?
- Pancreatic enzymes, that is, the powerful digestive juices may leak into the abdomen damaging other organs
- There may be decreased production of hormones like insulin, thereby affecting normal body sugar levels
- There may be profuse bleeding within the gland or in the abdominal cavity as it is supplied by many blood vessels. Pancreas also lies close to major blood vessels of body.
- Pancreas may become severely swollen or damaged, with no bleeding or digestive juice leak.
- There are various surrounding organs other than Pancreas which may be simultaneously affected in the injury.
What are various causes of Pancreas Injury?
- Blunt trauma – For example, blows to abdomen like punch/kick, fall over object, injury to mid back in children.
- Penetrating injury – Stab injury due to sharp object like knife over abdomen, flanks, mid back, Gunshot injury
What are the symptoms in patient of Pancreatic Trauma?
- Redness, bruising over abdomen
- Abdominal pain and swelling, board like rigid and painful abdomen
- Dizziness, light headedness, nausea-vomiting, fall in BP, suggesting blood loss
- Blood glucose level abnormalities
- Oily stools, loss of appetite, indigestion
How is Pancreatic Trauma diagnosed?
- A thorough history of patient, events of injury, and detailed examination
- Amylase, lipase blood levels and in abdominal fluid if any
- Abdominal Xray, CT scan, MRCP depending on doctor’s judgement
- Diagnostic laparoscopy in select cases
How is Pancreatic trauma treated?
- Treatment options depend on multiple factors – no major symptoms, no major blood loss apparent, then wait-and-watch approach may be adopted for around 72 hours. Development of symptoms requires intervention.
- Surgery is usually required, in form of opening the abdomen, assessing the extent of Injury and damage, and decision to salvage the pancreas or remove severely damaged portion.
- Supportive treatment in form of nutrition, infection control, blood replacement, etc. is necessary.
How is the outcome in such patients?
- Depends on severity of injury
- Minor injuries usually have good outcomes with no long-lasting effects
- Major injuries can be life threatening in immediate period and can also have long lasting effects due to irreversible damage to pancreas.
- Patients with pre-existing Pancreatic problems/diseases have poorer outcomes
- It is important to realise pancreatic trauma even in absence of typical symptoms for early treatment and life saving measures.
What is the outcome of patients of Pancreatic cancer?
Early detected tumour, small sized tumour, young age are favourable factors for good outcome. Unfortunately, most tumours are detected late when they start producing symptoms, when cure becomes unlikely.
