膵外傷におけるCT診断の有用性と限界の検討

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  • USEFULNESS AND LIMITATIONS OF COMPUTED TOMOGRAPHIC DIAGNOSIS IN PANCREATIC TRAUMAS

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The utility of abdominal computed tomography (CT) was evaluated in 8 patients with pancreatic trauma in an acute phase of injury. Abdominal CT findings seen in early period after injury were determined in 2 patients with type I injury, 2 patients with type II injury, and 1 patient with type IIIa injury, and 3 patients with type IIIb injury (The Japanese Association for the Surgery of Trauma Classification of Pancreatic Injuries). In patients with type II and III injuries, the adipose tissues of the pre-renal space, transverse mesocolon, and mesentery of the small intestine increased in density, suggesting severe pancreatic damage. Distinction between types II and III injuries was sometimes difficult. In one patinet who was suspected of pancreatic disruption on CT scan, intraoperative pancreatography revealed no major duct disruption, and in another patient, pancreatography showed major duct disruption, although CT suggested a type II injury. Since the key determinant of the outcome of pancreatic trauma is the presence or absence of ductal injury, pancreatography should be performed aggressively in such patients to discriminate type III without any delay and to avoid mis-judgement in selecting candidates for surgery.

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