URGENT ENDOSCOPIC RETROGRADE PANCREATOGRAPHY IN THE EVALUATION OF PANCREATIC TRAUMA

The use of endoscopic retrograde pancreatography (ERP) has been usually avoided in acute stage of pancreatitis (pancreatic trauma). However, for the past year we have applied ERP to five patients who were suspected to have pancreatic damage due to abdominal injury. The results reported herein have been very favorable . Case 1 caused by a car accident (hit against the steering wheel). ERP showed a lesion in the main pancreatic duct. The main pancreatic duct was cut off in the body of the pancreas (Figure 1). Cane 2 shows the damage received by a motorcycle collision. ERP showed the main pancreatic duct to be normal . However, the fact that residual contrast medium was detected in the subtunica suggested that the pancreas itself was damaged. Case 3 caused by a car accident (hit against the steering wheel). ERP showed the contrast medium leaked into the abdominal cavity, revealing that the pancreas in this area had been severely twisted and crushed. Fig 4 showed ERP obtained one month after operation. The main pancreatic duct remained in the head of the pancreas. Case 4 shows an injury incurred during a fight. ERP showed the contrast medium leaked from the branch to the uncus. Case 5 caused by a car accident (run over). ERP showed the contrast medium leaked in the abdominal cavity or the pancreas itself. In all the five cases the severity of damage to the main pancreatic duct and to the pancreas itself, etc. were clearly demonstrated. Not only was ERP found extremely useful in making a decision on the operative methods, but also no special complication occurred. It is concluded that more urgent endoscopic retrograde pancreatography should be more positively performed as a method for diagnosing pancreatic damages.