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Dorsal pancreatic artery injury caused by blunt trauma.

A 46-year-old man was the unrestrained driver of a vehicle that rolled down a 40-foot embankment. At the scene the patient was initially alert and oriented, complaining primarily of shortness of breath. Because of increasing respiratory distress, rapid sequence intubation was performed along with right tube thoracostomy for suspected pneumothorax. On arrival in the emergency department the patient was hemodynamically stable. Physical examination was remarkable for bilateral cephalohematomas, left periorbital ecchymosis, and a distended abdomen. There was no residual pneumothorax on chest radiograph. Abdominal ultrasonography demonstrated free intra-abdominal fluid. Computed tomography (CT) of the abdomen and pelvis demonstrated a large amount of free fluid and what appeared to be extravasation of oral contrast outside the stomach (Fig. 1) consistent with a ruptured hollow viscous (arrow). Coronal CT cuts (Fig. 2) showed contrast extravasation (arrow) around the pancreas. No free intraperitoneal air was seen. Shortly after CT scan he became hemodynamically unstable and was taken to the operating room for emergent laparotomy. At laparotomy a large stellate laceration of the right lobe of the liver and a grade IV splenic laceration were identified, requiring hepatorraphy and splenectomy. In addition, a partial avulsion of the dorsal pancreatic artery was identified as the source of the contrast extravasation in the lesser sac and was repaired primarily. Because of developing coagulopathy, temporary abdominal closure was performed, and the patient was returned to the intensive care unit for continued resuscitation. Successfully definitive abdominal closure was performed 48 hours later. Postoperative course was unremarkable and the patient was discharged home on posttrauma day 21. At last follow-up visit on postoperative day 41 the patient was doing well with no adverse sequelae.