Laboratory examinations revealed a white blood cell (WBC) count 14400/μL (normal 3500–8500), serum amylase (AMY) 1321 IU/L (normal 40–126), and C-reactive protein (CRP) 6.8 mg/dL (normal 0.0-0.5). Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated disruption of the pancreatic duct with extravasation into the peripancreatic fluid collection (Figures 2). A 5-French endoscopic nasopancreatic drainage (ENPD) tube was placed into the pancreatic duct across the duct disruption. A CT scan after ERCP revealed ENPD tube placed into pancreatic duct, and there was no exacerbation
of pancreatic injury or fluid collection (Figures 3). Her symptoms dramatically improved upon endoscopic treatment. ERCP on the 17th day after admission revealed a mild stricture at the injured duct without leakage (Figures 4), and the ENPD tube was exchanged for a 5-French 5-cm endoscopic pancreatic stent (EPS). Subsequent #PF-04929113 randurls[1|1|,|CHEM1|]# follow-up CT after tube exchange revealed remarkable improvement
of the injured pancreatic parenchyma and there is no fluid collection at the pancreatic head (Figures 5). On the 26th day, the patient was discharged from the hospital without symptoms or complications. Amylase remained within the normal range after ENPD drainage. Routine laboratory examinations were normal and EPS remain in situ. Figure 1 A computed tomography see more scan showed pancreatic parenchyma disruption with a small amount of peripancreatic fluid at the pancreatic head. Figure 2 Endoscopic retrograde cholangiopancreatography demonstrated disruption
of the pancreatic duct with extravasation into the peripancreatic fluid collection (arrow). Figure 3 A computed tomography scan after endoscopic retrograde cholangiopancreatography revealed endoscopic nasopancreatic drainage tube (arrow) placed into pancreatic SDHB duct, and there was no exacerbation of pancreatic injury or fluid collection. Figure 4 Endoscopic retrograde cholangiopancreatography revealed a mild stricture (arrow) at the injured duct without leakage. Figure 5 A computed tomography scan after tube exchange revealed remarkable improvement of the injured pancreatic parenchyma and resolution of the peripancreatic fluid collection. Discussion Pancreatic injury occurs in only 3% to 12% of all patients with severe abdominal trauma . The morbidity and mortality rates of pancreatic injury are high [2, 3]. Many pancreatic injuries remain undetected at first, and only become apparent when complications arise or other injuries are present; in more than 80% of patients, at least one other abdominal organ is also injured . Recently, the diagnostic evaluation of pancreatic injury has improved dramatically . On the other hand, it is occasionally difficult to diagnose pancreatic injury, because there are no specific signs, symptoms, or laboratory findings. Therefore, proper diagnosis and treatment of pancreatic injury in the acute phase is indispensable.