Blunt pancreatic fractures.

Study aim: The aim of this retrospective study was to report on seven blunt fractures of the pancreas and to emphasize the difficulties of their diagn osis and treatment as well as their severity. Patients and method: From October 1995 to March 2000, seven cases of blunt fracture of the pancreas were observed. The diagnosis was immediate in two cases, due to an emergency abdominal CTscan, and for the five other patient s it was postponed by 4 to 12 days because of the frequency and severity of the associated lesions present in five cases out of seven. A left splenopa ncreatectomy was performed in four patients; a late necrosectomy with exter nal drainage in two patients; and one patient was not operated on. Results: There was one postoperative death due to associated cerebral lesio ns. After left splenopancreatectomy a pancreatic fistula dried up in less t han a week in two patients. After necrosectomy and drainage, the operation was complicated in the two cases because of repetitive abscesses acid a lar ge and long-lasting pancreatic fistula. Conclusion: Blunt fractures of the pancreas are rare and serious lesions. T he diagnosis is often made during an emergency laparotomy for hemoperitoneu m or peritonitis. The existence of a canal rupture confirmed by transpapill ary wirsungography, or better by wirsungo-MRI, is a strong arguing point fo r a left splenopancreatectomy when the patient's state allows ii. Simple ex ternal drainage is only justified when the left splenopancreatectomy isn't possible. (C) 2001 Editions scientifiques et medicales Elsevier SAS.