CT GRADING OF BLUNT PANCREATIC INJURIES - PREDICTION OF DUCTAL DISRUPTION AND SURGICAL CORRELATION

Purpose: The purpose of our study was to devise a CT grading scheme fo r blunt pancreatic injuries (BPIs) and to apply it to predict the pres ence or absence of ductal disruption. Method: We retrospectively revie wed CT scans of 22 patients with proven BPIs. We graded these injuries on CT (A, BI, BII, CI, and CII) based on the (a) presence or absence of pancreatic lacerations, (b) site of lacerations, and (c) depth of l acerations. CT grading was correlated with surgical findings for gland ular and ductal injuries. Results: Main pancreatic ducts were intact i n 2 patients with normal CT scans and in all grade A injuries (n = 10) . Distal pancreatic ducts were disrupted in all grade B injuries (BI, n = 1; BII, n = 4). Of five grade C injuries, three CII injuries had d isruption of proximal pancreatic duct, one CII injury had disruption o f minor duct, and one CI injury had an intact ductal system. Conclusio n: CT grading of BPIs was useful in predicting ductal integrity or dis ruption. Ductal disruption was likely present if the pancreas appeared to have a transection or deep laceration on CT scans. It was accurate in grade A and B injuries. Overestimation could occur in grade CI and CII injuries.