Traumatic transection of the pancreatic duct

A young man presented after a mountain biking accident having received a sharp blow from his handlebars to just below his right costal margin. Although initially he was clinically well and his primary investigations were normal, he was admitted for observation. After becoming peritonitic, his amylase increased to 502 U/ml, and an axial CT scan showed transection of the pancreas. An endoscopic retrograde cholangio-pancreatography (ERCP) was arranged in the operating department, confirming ductal damage. A stent was placed to bridge the pancreatic duct preoperatively, and a laparotomy lavage was carried out and an external drain placed. The patient recovered well and 12 weeks later, after the stent was removed, there was no evidence of pancreatic stricture. Pancreatic injuries must be suspected in blunt abdominal trauma, and preoperative endoscopic stenting may provide the definitive procedure for ductal injuries.