ROENTGENOGRAPHIC FINDINGS IN LOCALIZED TRAUMA TO THE PANCREAS IN CHILDREN

¹ From the Departments of Radiology and Surgery, University of Rochester Medical Center, Rochester, New York

The roentgenographic features of localized trauma to the pancreas in children are presented from a review of 5 cases. Plain abdominal findings are those of localized ileus in the upper quadrants as shown by an air-distended loop of small or large bowel in combination with inflammation of peripancreatic tissues, and indicated by increased density with increased spacing between adjacent air-containing viscera.

The radiopaque contrast findings are coarsened mucosal markings, duodenal atony with transient mid-duodenal obstruction, widening of the duodenal loop, stretching of the proximal jejunum, the "reversed 3" sign and mass displacement of viscera by hematoma formation. Roentgenology can be further helpful in assessing progress and demonstrating complications.

The innocent source and apparent trivial force of trauma, usually sustained at play, is noted. Delayed onset of symptoms, abdominal pain out of proportion to the early physical findings, vomiting and restlessness are the significant clinical features.

Suspicion of pancreatic trauma from the symptoms and signs in association with highly suggestive roentgenographic findings, should prompt a serum amylase determination which, when elevated, is diagnostic of injury to this organ.

Early surgical intervention with adequate drainage of the area of injury is the mainstay of treatment.

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