Article originalLes fractures isthmiques du pancréasBlunt pancreatic fractures.

Study aim: The aim of this retrospective study was to report on seven blunt fractures of the pancreas and to emphasize the difficulties of their diagnosis and treatment as well as their severity. Patients and method: From October 1995 to March 2000, seven cases of blunt fracture of the pancreas were observed. The diagnosis was immediate in two cases, due to an emergency abdominal CTscan, and for the five other patients it was postponed by 4 to 12 days because of the frequency and severity of the associated lesions present in five cases out of seven. A left splenopancreatectomy was performed in four patients; a late necrosectomy with external drainage in two patients; and one patient was not operated on. Results: There was one postoperative death due to associated cerebral lesions. After left splenopancreatectomy a pancreatic fistula dried up in less than a week in two patients. After necrosectomy and drainage, the operation was complicated in the two cases because of repetitive abscesses and a large and long-lasting pancreatic fistula. Conclusion: Blunt fractures of the pancreas are rare and serious lesions. The diagnosis is often made during an emergency laparotomy for hemoperitoneum or peritonitis. The existence of a canal rupture confirmed by transpapillary wirsungography, or better by wirsungo-MRI, is a strong arguing point for a left splenopancreatectomy when the patient’s state allows it. Simple external drainage is only justified when the left splenopancreatectomy isn’t possible.