Abstract
A 25-year-old man accidentally fell from a cliff and hit his right flank on the ground while camping. Initially, he was able to barely walk, but he ultimately became unable to walk at all due to severe flank pain. He had no remarkable personal or family history and was a social drinker. Upon arrival, he showed clear consciousness but was in a hemorrhagic shock state. Enhanced computed tomography (CT) revealed extravasation of contrast medium from the injured right kidney with massive retroperitoneal hematoma. He underwent massive blood transfusion and tracheal intubation followed by renal embolization. His vital signs stabilized on hospital day 2, and he was extubated on day 3. On days 4 and 5, a blood examination revealed increased levels of amylase (360 and 904 IU/L, respectively). Enhanced CT on day 5 did not show signs of severe acute pancreatitis. The maximum amylase level was 1041 IU/L on day 6 and decreased day by day without deterioration of the severity of his acute pancreatitis. He was discharged on day 14. The subacute phase of posttraumatic acute pancreatitis in the present case may have been induced not by direct injury to the pancreas but by several causative factors, such as shock, increased pressure of the retroperitoneal space, or the release of inflammatory mediators from injured tissues or hematoma.
Highlights
Acute pancreatitis, an inflammatory disorder of the pancreas, is the leading cause of admission to the hospital for gastrointestinal disorders in many countries
His colleague called an ambulance. He had no remarkable personal or family history and was a social drinker. He was transported to a local hospital, but computed tomography (CT) revealed right renal injury with massive retroperitoneal hematoma, so he was transported to our hospital by a physician-staffed helicopter 2 hours after the accident
We encountered a case of posttraumatic acute pancreatitis that occurred four days after renal injury with massive retroperitoneal hematoma
Summary
An inflammatory disorder of the pancreas, is the leading cause of admission to the hospital for gastrointestinal disorders in many countries. Acute pancreatitis induced by traumatic injury is rare and difficult to diagnose. The most evident findings of posttraumatic pancreatitis are blood, edema, and soft tissue infiltration of the anterior pararenal space [4]. The typical clinical triad of posttraumatic pancreatitis is upper abdominal pain, leukocytosis, and elevated serum amylase levels during the first 24 hours. Delayed diagnoses of posttraumatic pancreatitis are associated with high morbidity and mortality rates. We report a case of complicating posttraumatic pancreatitis four days after renal injury with massive retroperitoneal hematoma and discuss the mechanism underlying the occurrence of posttraumatic pancreatitis in the present case
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