Successful treatment of a grade IIIb traumatic pancreatic injury with a pancreatic duct stent: a case report.

Pancreatic duct injury (PDI) is a rare condition with mild clinical symptoms.It is important to accurately assess PDI presence to determine the treatment strategy for traumatic pancreatic injury. Pancreatic deep injuries associated with main PDI due to abdominal trauma may require surgical intervention; however, recent reports have described nonsurgical treatment using endoscopic pancreatic duct drainage. We report a case of traumatic pancreatic injury where surgical intervention was avoided through endoscopic pancreatic duct drainage. A 36-year-old man was assaulted and brought to our hospital for abdominal pain and bruising that did not improve the next day. Blood tests revealed elevated creatine kinase and amylase levels. Contrast-enhanced computed tomography revealed a ruptured pancreatic body, retroperitoneal and abdominal cavity bleeding, and inflammation around the ascending colon. Based on these findings, the patient was diagnosed with a traumatic pancreatic injury. Although pancreatic duct rupture was suspected, imaging studies raised concerns about ascending colon injury, leading to a decision for surgery. During surgery, no intestinal injuries, parenchymal damage, or subcapsular hemorrhage were found. Postoperatively, amylase levels in the drainage fluid were elevated (> 30,000), suggesting pancreatic duct rupture and fluid leakage. Endoscopic retrograde cholangiopancreatography was then performed. Contrast agent leakage outside the pancreatic duct was observed, and a pancreatic duct stent was placed beyond the rupture site using a guidewire. Following the procedure, there was no further pancreatic fluid leakage, and blood test results and symptoms improved.