Blunt pancreatic trauma: a difficult injury.

The diagnosis and initial management of hemodynamically stable blunt pancreatic trauma should include a high index of suspicion when a patient has sustained a severe force vector in the anterior-posterior direction of the abdominal cavity. Patients who are hemodynamically stable should have physical examination, computed tomography (CT) of the abdomen, and serial determinations of serum amylase levels. If CT shows any suggestion of injury to the pancreas, such as fluid between the splenic vein and the posterior border of the pancreas, follow-up endoscopic retrograde pancreatography (ERP) should be done. In patients with a significant retroperitoneal hematoma, ERP should be followed by noncontrast CT for the evaluation of extravasation of contrast material. If ERP shows ductal disruption or follow-up CT shows extravasation of contrast, operative management is indicated. The astute physician should always remember that the most difficult aspect of pancreatic injury is timely diagnosis.