Takishima et al classified injuries to the pancreatic duct following blunt trauma to the abdomen. The severity of the injury can help determine the optimum management of the patient. The authors are from Kitasato University in Kanagawa, Japan.
Imaging studies: ERCP
Injury to the Pancreas
Class
normal pancreatic duct system (no extravasation of contrast material; no ductal obstruction anywhere)
1
contrast material has leaked from a branch of the pancreatic duct but is contained within the pancreatic parenchyma
2a
contrast material has leaked from a branch of the pancreatic duct into the retroperitoneal space
2b
injury to the main pancreatic duct in the body and/or tail
3a
injury to the main pancreatic duct in the head
3b
where:
• The right margin of the superior mesenteric vein was used to separate the pancreatic head from the remainder of the organ.
• Since Class 1 injuries mention duct obstruction I assume that these would apply to the other classes as well.
Class
Management
1 or 2a
nonsurgical OR laparotomy without pancreatic resection if duodenum injured
2b
laparotomy with drainage OR laparotomy without pancreatic resection if duodenum injured
3a
distal pancreatectomy
3b
Roux-en-Y pancreaticojejunostomy OR pancreaticoduodenectomy
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