Conservative Management of Isolated Proximal Traumatic Pancreatic Injury: A Case Report

Background: Blunt traumatic pancreatic injuries are rare conditions in case of motor vehicle collision (MVC) and isolated injuries even rarer. Surgical approach is usually preferred in case of advanced pancreatic injuries. In this study we try to shed the light on the role of completely conservative approach in the management of a proximal pancreatic injury. Case Summary: A 19-year-old male patient presented to the ER three days following MVC with upper abdominal pain. Abdominal US showed free intraperitoneal fluids and laboratory results showed elevated total leukocyte count, serum amylase and lipase. CT showed transection at pancreatic head which was grade 5 with free intrabdominal fluids; hence isolated pancreatic injury was diagnosed. At that point, the patient was hemodynamically stable and conservative management was implemented. He was admitted in the ICU for three days followed by 28 days in the ward where patient condition was closely monitored on daily bases. Serial interval imaging showed spontaneous resolution of the intraperitoneal collection together with improvement of the injury, respectively. After completing his course, the patient was discharged and monitored as an outpatient. Conclusion: Conservative treatment can be adopted in patients with proximal pancreatic injuries with complete duct disruption in otherwise hemodynamically stable patients.