COMPUTED-TOMOGRAPHY - AN UNRELIABLE INDICATOR OF PANCREATIC TRAUMA

Computed tomography (CT) is currently the modality of choice in evalua ting pancreatic injury in patients suffering abdominal trauma who do n ot require immediate exploration. The purpose of this study was to det ermine the reliability of initial CT scanning in the detection of panc reatic trauma. A retrospective review was performed of all patients ad mitted to two Level 1 trauma centers over a 10-year period. Those pati ents identified with pancreatic injury who underwent initial evaluatio n with CT scanning were reviewed for clinical course and comparison of CT results with findings at laparotomy. Seventy-two patients of 16,18 8 admissions (0.4%) were identified with pancreatic injury. Mechanism of injury was blunt in 27 (37%), gunshot wound in 32 (45%), and stab w ound in 13 (18%). There were 18 (25%) grade I, 32 (45%) grade II, 16 ( 22%) grade III, and 5 (7%) grade IV pancreatic injuries. Seventeen of the 72 patients with pancreatic injury underwent initial abdominal CT. The pancreas was normal on CT in 9 and of these, 8 underwent explorat ion, most commonly secondary to splenic injury. Three were found to ha ve grade I pancreatic injury, two grade II, and three grade III, which required distal pancreatectomy. The pancreas was abnormal on CT in ei ght patients, and of these three underwent exploration. One patient ha d a grade I pancreatic injury, and another had a grade II injury, both confirmed at laparotomy. One patient had an injury upgraded from II o n CT to III at exploration and underwent distal pancreatectomy. The me an pancreatic injury by CT was 0.45 versus 2.0 on exploration (P < 0.0 01). Injury to the pancreas following blunt trauma is rare. Computed t omography will often miss or underestimate pancreatic injuries that re quire operative treatment, and normal findings on initial scan should not be relied upon to exclude significant pancreatic trauma.