A CASE OF MULTIPLE ABDOMINAL ORGANS INJURIES WITH UNRECOGNIZED PANCREATIC TRAUMA AT THE FIRST OPERATION

Abstract

It is rather difficult to diagnose precisely the injured sites in multiple abdominal organs trauma. A case of suicided multile abdominal organs injuries with unrecognized pancreatic trauma at the first operation is reported here. A 44-year-old female with suicided multiple abdominal organs trauma underwent emergent surgical repairements for hepatic, gastric, duodenal, jejunal, and colonic injuries. In the postoperative course, the patient had high fever and repeated abdominal pains because of a left subphrenic abscess formation. Despite of drainage of the abscess, the elevation in pancreatic enzymes (amylase, lipase) were continued. CT scan and US revealed the pseudocysts and progressive pancreatic swelling. The patient was transferred to the hospital with the diagnosis of traumatic pancreatitis. ERCP disclosed the injured pancreatic main duct in the tail portion. For its refractory clinical course for the conservative therapies, a distal pancreatectomy was performed 6 months after the first operation. The unrecognized pancreatic injury at the first look led to the prolonged treatment course with multiple surgeries. This case suggested the importance of preoperative pancreatography and intraoperative investigation of the pancreas in suspected pancreatic injuries.