An Unusual Case of Isolated Pancreatitis Secondary to Blunt Abdominal Trauma

Abstract

Acute pancreatitis is an inflammatory condition affecting a large population and resulting in one of the most common causes of gastrointestinal hospitalizations in the United States. The pathogenesis resulting in pancreatic injury has multiple etiologies with gallstones and alcohol consumption contributing to a large majority of cases. Consequently, one uncommon cause of acute pancreatitis, direct abdominal trauma, often gets overlooked. This case describes a 20-year-old male with no past medical history or surgical interventions presenting to the hospital with two days worth of abdominal pain. Physical exam was negative for erythema, ecchymosis and lacerations but further questioning revealed a recent history of an altercation resulting in multiple blunt blows to the abdomen. CT abdomen with contrast was positive for an edematous appearing pancreatic tail with surrounding soft tissue stranding; no pancreatic fluid collections, normal gallbladder and no intrahepatic or extrahepatic biliary ductal dilation. Pancreatitis has a multitude of etiologies and practitioners should address the insulting event as well as the pathological sequelae to prevent reoccurrence of the condition. The importance of taking a full and thorough history should not be overlooked; this could lead to misdiagnosis and misjudgment of the underlying pathological process. We propose the notion that there is a significant number of patients diagnosed with idiopathic pancreatitis who may have more accurately been diagnosed with traumatic pancreatitis with a more thorough history. Additionally, due to the pancreas's retroperitoneal location, isolated injury with abdominal trauma, such as in this patient, is quite rare. It is critical to differentiate the underlying cause of acute pancreatitis to further counsel patients about avoidance of precipitating factors. We would like to stress the importance of obtaining a thorough history and ruling out alternative causes of patient presentation as management differs greatly after treatment of the acute phase reaction. In patients with traumatic pancreatitis, physicians should establish that there were no residual abdominal injuries and advise patients to restrain from any activities that would result in any sequential abdominal trauma.

Keywords: acute pancreatitis; blunt abdominal trauma; idiopathic pancreatitis; intra-abdominal injury; pancreatic tail; pancreatic tail injury; pancreatitis; penetrating trauma; torso trauma; traumatic pancreatitis.

Figure 1. Pancreatic Tail Injury on CT Imaging