Post-Traumatic Necrohemorragic Pancreatitis Caused by an Air Gun

Rocío González López,J Félix Arija Val,Mohammed Salem Ali,Eva Iglesias Porto,Carlos Gegúndez Gómez,Marlen Alvite Canosa

doi:10.4236/ss.2011.29101

Abstract

Penetrating abdominal trauma is the main cause of pancreatic lesions and delay in diagnosis or treatment can increase morbimortality. We present a case of acute necrohemorrhagic pancreatitis (ANHP) secondary to airgun injury associated with pulmonary embolism caused by the projectile in a 36 year old man. He underwent urgent surgery, appreciating pancreatic contusion but not visualizing the projectile, located by CT scan 3mm from the inferior vena cava. The patient underwent further surgery 48 hours later for necrosectomy and the insertion of an irrigation tube, due to ANHP after the migration of the projectile into the lung. This case underlines the clinical relevance of pancreatic lesion in patients with a penetrating abdominal trauma, the diagnostic difficulty and the surgical strategy, as well as the repercussions of the migration of a foreign body through the blood stream, crossing the right heart chambers and becoming lodged in the lung.

Highlights

We present a case of acute necrohemorrhagic pancreatitis (ANHP) secondary to airgun injury associated with pulmonary embolism caused by the projectile in a 36 year old man
The patient underwent further surgery 48 hours later for necrosectomy and the insertion of an irrigation tube, due to ANHP after the migration of the projectile into the lung. This case underlines the clinical relevance of pancreatic lesion in patients with a penetrating abdominal trauma, the diagnostic difficulty and the surgical strategy, as well as the repercussions of the migration of a foreign body through the blood stream, crossing the right heart chambers and becoming lodged in the lung
We present a case of acute necrohemorrhagic pancreatitis (ANHP) secondary to penetrating abdominal trauma by airgun associated with pulmonary embolism caused by the projectile

Summary

Clinical Case

The incidence of pancreatic lesions in abdominal traumas is low, 0.2% to 6%, penetrating abdominal traumas, mainly due to sharp weapons or fire arms, being the most frequent cause [1]. 48 hours after the surgical intervention he presented significant clinical worsening with intense abdominal pain, fever, tachycardia and high leukocytosis with neutrophilia, for which reason a new thoracic and abdominal TC scan was carried out, showing a large amount of free intra-abdominal fluid, mainly right pararenal and peripancreatic and destructuring of the pancreatic head, possibly related to post-traumatic pancreatitis as well as objectifying the projectile lodged in the left inferior pulmonary lobe (Figure 2). Given these findings and the suspicion of severe acute post-traumatic pancreatitis, it was decided to carry out a new urgent surgical intervention, finding a large amount of serosanguineous fluid and acute necrohemorrhagic pancreatitis, mainly affecting the pancreatic head. After 10 months of follow-up the patient is asymptomatic and with the projectile still lodged in the left inferior pulmonary lobe

Discussion

Conclusions