Abstract
BackgroundPancreatic injuries are rare in cases of blunt abdominal trauma and therefore easily misdiagnosed at time of hospital admission. They are associated with a significantly elevated morbidity and lethality. Bicycle handlebar injuries are the most common cause of pancreatic trauma in children and adolescents.Case presentationWe report two cases of a 23-year-old Caucasian woman and a 15-year-old Caucasian boy who presented to our clinic with a similar history of a bicycle accident on 2 consecutive days. Both suffered from a fall from a bicycle with bicycle handlebar injury 4 and 6 days prior to admission in our clinic. Emergency distal pancreatectomies were performed in both cases.ConclusionsPancreatic injuries must be highly suspected in bicycle handlebar injuries, even if amylase/lipase levels or ultrasound findings seem unremarkable. The best initial strategies are early computed tomography and a quick referral to a level 1 trauma center. Distal pancreatectomy is the treatment of choice in cases of complete rupture of the pancreatic body.
Highlights
ConclusionsPancreatic injuries must be highly suspected in bicycle handlebar injuries, even if amylase/lipase levels or ultrasound findings seem unremarkable
Pancreatic injuries are rare in cases of blunt abdominal trauma and misdiagnosed at time of hospital admission
Pancreatic injuries must be highly suspected in bicycle handlebar injuries, even if amylase/lipase levels or ultrasound findings seem unremarkable
Summary
Surgeons should be aware of pancreatic trauma especially in blunt abdominal accidents involving bicycle handlebar injuries even in cases of normal serum amylase levels or initially unremarkable ultrasound findings. A complete diagnostic workup requires repeat physical examination, sequential amylase/lipase tests, sonography, early CT of the abdomen or MRI, as well as a quick referral to a level 1 trauma center. While lower grade pancreatic injuries can respond to conservative management, complete pancreatic ruptures must be treated surgically
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