Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00032260.xml
Download PDF
Digestive Disease Interventions
DOI: 10.1055/s-0045-1808264
DOI: 10.1055/s-0045-1808264
Review Article
Interventional Radiology in Management of Pancreatic Trauma
Abstract
Pancreatic traumatic injuries are uncommon but can have devastating clinical consequences and prognosis is often associated with high morbidity and mortality. Interventional radiology plays an important role in both early and late clinical presentations of pancreatic trauma to decrease the rates of morbidity and mortality, major complications, and improve clinical outcomes. This article will describe image-guided techniques to diagnose and manage pancreatic trauma and associated complications.
Publication History
Received: 05 December 2024
Accepted: 03 April 2025
Article published online:
22 May 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Ayoob AR, Lee JT, Herr K. et al. Pancreatic trauma: imaging review and management update. Radiographics 2021; 41 (01) 58-74
- 2 Cakmak V, Herek D, Oskay A, Gungör G, Çakmak P, Özen M. Pancreatic injury due to blunt trauma on CT: does retropancreatic fat tissue reduce the severity of pancreatic injury?. Ulus Travma Acil Cerrahi Derg 2024; 30 (04) 263-270
- 3 Jurkovich GJ, Carrico CJ. Pancreatic trauma. Surg Clin North Am 1990; 70 (03) 575-593
- 4 Wolf A, Bernhardt J, Patrzyk M, Heidecke C-D. The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma. Surg Endosc 2005; 19 (05) 665-669
- 5 Linsenmaier U, Wirth S, Reiser M, Körner M. Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology. Radiographics 2008; 28 (06) 1591-1602
- 6 Teh SH, Sheppard BC, Mullins RJ, Schreiber MA, Mayberry JC. Diagnosis and management of blunt pancreatic ductal injury in the era of high-resolution computed axial tomography. Am J Surg 2007; 193 (05) 641-643 , discussion 643
- 7 Choi AY, Bodanapally UK, Shapiro B, Patlas MN, Katz DS. Recent advances in abdominal trauma computed tomography. Semin Roentgenol 2018; 53 (02) 178-186
- 8 Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics 2004; 24 (05) 1381-1395
- 9 Bradley III EL, Young Jr PR, Chang MC. et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg 1998; 227 (06) 861-869
- 10 Rahnemai-Azar AA, Sutter C, Hayat U, Glessing B, Ammori J, Tavri S. American Journal of Roentgenology. Multidisciplinary management of complicated pancreatitis: what every interventional radiologist should know. AJR Am J Roentgenol 2021; 217 (04) 921-932
- 11 Moore EE, Cogbill TH, Malangoni MA. et al. Organ injury scaling, II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma 1990; 30 (11) 1427-1429
- 12 Mulholland MW, Lillemoe KD, Doherty GM, Maier RV, Simeone DM, Upchurch GR. Greenfield's Surgery: Scientific Principles & Practice. Lippincott Williams & Wilkins; 2012
- 13 Hamidian Jahromi A, D'Agostino HR, Zibari GB, Chu QD, Clark C, Shokouh-Amiri H. Surgical versus nonsurgical management of traumatic major pancreatic duct transection: institutional experience and review of the literature. Pancreas 2013; 42 (01) 76-87
- 14 Iacono C, Zicari M, Conci S. et al. Management of pancreatic trauma: a pancreatic surgeon's point of view. Pancreatology 2016; 16 (03) 302-308
- 15 Mahadevan V. Anatomy of the pancreas and spleen. Surgery (Oxf) 2019; 37 (06) 297-301
- 16 Endler GT, Curfman KR, Hwang JH, Gray JL. A complicated entity: acute celiac artery dissection with resultant pancreatitis, duodenitis, and cholecystitis. Case Rep Vasc Med 2020; 2020: 8453168
- 17 Beenen LF, Sierink JC, Kolkman S. et al. Split bolus technique in polytrauma: a prospective study on scan protocols for trauma analysis. Acta Radiol 2015; 56 (07) 873-880
- 18 Boscak AR, Shanmuganathan K, Mirvis SE. et al. Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology 2013; 268 (01) 79-88
- 19 Sharbidre KG, Galgano SJ, Morgan DE. Traumatic pancreatitis. Abdom Radiol (NY) 2020; 45 (05) 1265-1276
- 20 Potoka DA, Gaines BA, Leppäniemi A, Peitzman AB. Management of blunt pancreatic trauma: what's new?. Eur J Trauma Emerg Surg 2015; 41 (03) 239-250
- 21 Park Y, Kim Y, Lee J, Cho BS, Lee JY. Pancreaticoduodenal arterial hemorrhage following blunt abdominal trauma treated with transcatheter arterial embolization: Two case reports. Medicine (Baltimore) 2020; 99 (40) e22531
- 22 Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K. Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol 2000; 11 (01) 66-72
- 23 Gambiez LP, Ernst OJ, Merlier OA, Porte HL, Chambon JP, Quandalle PA. Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis. Arch Surg 1997; 132 (09) 1016-1021
- 24 Obon-Dent M, Shabaneh B, Dougherty KG, Strickman NE. Spontaneous celiac artery dissection case report and literature review. Tex Heart Inst J 2012; 39 (05) 703-706
- 25 Amabile P, Ouaïssi M, Cohen S, Piquet P. Conservative treatment of spontaneous and isolated dissection of mesenteric arteries. Ann Vasc Surg 2009; 23 (06) 738-744
- 26 Berczeli M, Chinnadurai P, McFall RG, Diaz O, Lumsden AB. Endovascular treatment of pancreaticoduodenal aneurysm with braided stent-assisted coil embolization using intraoperative cone-beam computed tomography guidance. J Vasc Surg Cases Innov Tech 2022; 8 (02) 265-270
- 27 Kim H-K, Jung HK, Cho J, Lee J-M, Huh S. Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management. J Vasc Surg 2014; 59 (02) 465-472
- 28 Park YJ, Park KB, Kim D-I, Do YS, Kim D-K, Kim Y-W. Natural history of spontaneous isolated superior mesenteric artery dissection derived from follow-up after conservative treatment. J Vasc Surg 2011; 54 (06) 1727-1733
- 29 Shin J, Hong HP, Kim Y-W. Ruptured pancreaticoduodenal artery aneurysm in a patient with celiac artery dissection: a case report. Vasc Endovascular Surg 2023; 57 (07) 768-770
- 30 Watanabe A, Kohtake H, Furui S, Takeshita K, Ishikawa Y, Morita S. Celiac artery dissection seen with ruptured pancreaticoduodenal arcade aneurysms in two cases of celiac artery stenosis from compression by median arcuate ligament. J Vasc Surg 2012; 56 (04) 1114-1118
- 31 Murata S, Tajima H, Fukunaga T. et al. Management of pancreaticoduodenal artery aneurysms: results of superselective transcatheter embolization. AJR Am J Roentgenol 2006; 187 (03) W290-W298
- 32 Iyomasa S, Matsuzaki Y, Hiei K, Sakaguchi H, Matsunaga H, Yamaguchi Y. Pancreaticoduodenal artery aneurysm: a case report and review of the literature. J Vasc Surg 1995; 22 (02) 161-166
- 33 Coll DP, Ierardi R, Kerstein MD, Yost S, Wilson A, Matsumoto T. Aneurysms of the pancreaticoduodenal arteries: a change in management. Ann Vasc Surg 1998; 12 (03) 286-291
- 34 Seiler CA, Boss MA, Czerniak A, Berne TV, Blumgart LH. Vascular complications in chronic pancreatitis. Dig Surg 1997; 14 (02) 107-112
- 35 Mallick IH, Winslet MC. Vascular complications of pancreatitis. JOP 2004; 5 (05) 328-337
- 36 Carr JA, Cho JS, Shepard AD, Nypaver TJ, Reddy DJ. Visceral pseudoaneurysms due to pancreatic pseudocysts: rare but lethal complications of pancreatitis. J Vasc Surg 2000; 32 (04) 722-730
- 37 Sparrow P, Asquith J, Chalmers N. Ultrasonic-guided percutaneous injection of pancreatic pseudoaneurysm with thrombin. Cardiovasc Intervent Radiol 2003; 26 (03) 312-315
- 38 de Perrot M, Berney T, Bühler L, Delgadillo X, Mentha G, Morel P. Management of bleeding pseudoaneurysms in patients with pancreatitis. Br J Surg 1999; 86 (01) 29-32
- 39 Bernades P, Baetz A, Lévy P, Belghiti J, Menu Y, Fékété F.. Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients. Dig Dis Sci 1992; 37 (03) 340-346
- 40 Wong S, Cristescu M, Angle JF. et al. Diagnosis and treatment of isolated splenic vein thrombosis. J Vasc Intervent Radiol 2014; 25 (03) S194-S195
- 41 Bradley III EL. The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery. Int J Pancreatol 1987; 2 (02) 87-92
- 42 Mowery NT, Bruns BR, MacNew HG. et al. Surgical management of pancreatic necrosis: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017; 83 (02) 316-327
- 43 Boraschi P, Donati F, Cervelli R, Pacciardi F. Secretin-stimulated MR cholangiopancreatography: spectrum of findings in pancreatic diseases. Insights Imaging 2016; 7 (06) 819-829
- 44 Ito Y, Kenmochi T, Irino T. et al. Endoscopic management of pancreatic duct injury by endoscopic stent placement: a case report and literature review. World J Emerg Surg 2012; 7 (01) 21
- 45 Shimizu D, Yamano T, Kudo Y. et al. Diagnostic and therapeutic role of endoscopic retrograde pancreatography and stent placement for grade IV blunt pancreatic trauma: a case report. Trauma Case Rep 2020; 28: 100319
- 46 Kim SH, Kim KH. Conservative treatment using an endoscopic pancreatic stent in a patient with delayed diagnosis of pancreatic injury after blunt trauma: a case report. Trauma Case Rep 2017; 7: 15-18
- 47 Shah KK, Shah KK, Singh M, Singh J, Sheikh MY. Blunt trauma to the main pancreatic duct: cut or stent?: 184. Am J Gastroenterol 2007; 102: S184
- 48 Søreide K, Weiser TG, Parks RW. Clinical update on management of pancreatic trauma. HPB (Oxford) 2018; 20 (12) 1099-1108
- 49 O'Keefe SJD, Graham T, Coté GA, Whitcomb DC, Evans A, Soni D. Early enteral feeding in severe acute pancreatitis: a randomized clinical trial between gastric vs distal jejunal feeding. Tech Innov Gastrointest Endosc 2023; 25 (04) 337-346
- 50 Meier R, Ockenga J, Pertkiewicz M. et al; DGEM (German Society for Nutritional Medicine), ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN guidelines on enteral nutrition: pancreas. Clin Nutr 2006; 25 (02) 275-284
- 51 Zhao K, Adam SZ, Keswani RN, Horowitz JM, Miller FH. Acute pancreatitis: revised Atlanta classification and the role of cross-sectional imaging. AJR Am J Roentgenol 2015; 205 (01) W32-41
- 52 Banks PA, Bollen TL, Dervenis C. et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62 (01) 102-111
- 53 Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13 (04, Suppl 2): e1-e15
- 54 van Grinsven J, van Santvoort HC, Boermeester MA. et al; Dutch Pancreatitis Study Group. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol 2016; 13 (05) 306-312
- 55 Salahia G, Chin SC, Zealley I, White RD. The role of interventional radiology in the management of pancreatic pathologies. J Gastrointest Abdomin Radiol 2020; 3: 99-113
- 56 Henriksen FW, Hancke S. Percutaneous cystogastrostomy for chronic pancreatic pseudocyst. Br J Surg 1994; 81 (10) 1525-1528
- 57 Khreiss M, Zenati M, Clifford A. et al. Cyst gastrostomy and necrosectomy for the management of sterile walled-off pancreatic necrosis: a comparison of minimally invasive surgical and endoscopic outcomes at a high-volume pancreatic center. J Gastrointest Surg 2015; 19 (08) 1441-1448
- 58 Swartz DK, Obando J. Endoscopic management of peri-pancreatic collections. Gastroenterol Res Pract 2012; 2012: 906381
- 59 Gao L, Zhang JZ, Gao K. et al. Management of colonic fistulas in patients with infected pancreatic necrosis being treated with a step-up approach. HPB (Oxford) 2020; 22 (12) 1738-1744
- 60 Jiang W, Tong Z, Yang D. et al. Gastrointestinal fistulas in acute pancreatitis with infected pancreatic or peripancreatic necrosis: a 4-year single-center experience. Medicine (Baltimore) 2016; 95 (14) e3318
- 61 Mauri G, Mattiuz C, Sconfienza LM. et al. Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review. Insights Imaging 2015; 6 (02) 231-239
- 62 Mauri G, Sconfienza LM, Fiore B. et al. Post-surgical enteric fistula treatment with image-guided percutaneous injection of cyanoacrylic glue. Clin Radiol 2013; 68 (01) 59-63
- 63 Gmeinwieser J, Holstege A, Zirngibl H. et al. Successful percutaneous treatment of infected necrosis of the body of the pancreas associated with segmental disruption of the main pancreatic duct. Gastrointest Endosc 2000; 52 (03) 413-415
- 64 Logue JA, Carter CR. Minimally invasive necrosectomy techniques in severe acute pancreatitis: role of percutaneous necrosectomy and video-assisted retroperitoneal debridement. Gastroenterol Res Pract 2015; 2015: 693040
- 65 Garg R, Gupta S, Singh A, Simonson MT, Rustagi T, Chahal P. Hydrogen peroxide assisted endoscopic necrosectomy for walled-off pancreatic necrosis: a systematic review and meta-analysis. Pancreatology 2021; 21 (08) 1540-1547