Early computed tomography may miss main pancreatic duct injury in distal pancreatic trauma: a prospective surgically verified diagnostic accuracy study.

PURPOSE: To assess the diagnostic performance of computed tomography (CT) for predicting main pancreatic duct injury in surgically explored patients with distal pancreatic trauma.

METHODS

We conducted a prospective single-center diagnostic accuracy study from August 2024 to March 2026. Consecutive patients with distal pancreatic trauma underwent contrast-enhanced abdominal CT before surgery. On CT, main pancreatic duct injury was defined by either a deep pancreatic parenchymal laceration involving at least 50% of pancreatic thickness or complete pancreatic transection. CT findings were compared with intraoperative assessment as the reference standard.

RESULTS

Forty-two patients were included; 39 (92.9%) had intraoperatively confirmed main pancreatic duct injury. CT correctly classified 37 patients (36 true positives and 1 true negative), with 3 false-negative and 2 false-positive results. Sensitivity, positive predictive value, specificity, negative predictive value, and overall accuracy were 92.3% (95% CI: 79.1-98.4%), 94.7% (95% CI: 82.3-99.4%), 33.3% (95% CI: 0.8-90.6%), 25.0% (95% CI: 0.6-80.6%), and 88.1% (95% CI: 73.6-96.5%), respectively. All false-negative results occurred after early CT, performed 3-7 h after trauma. No clear pancreatic laceration was seen on the initial scan, but the injuries became more apparent on repeat CT.

CONCLUSION

In surgically explored patients with distal pancreatic trauma, CT criteria based on a deep parenchymal laceration involving at least 50% of gland thickness or complete transection showed high sensitivity for predicting main pancreatic duct injury. However, specificity and negative predictive value were imprecise because very few duct-intact patients underwent surgical verification. All diagnostic estimates should therefore be interpreted in the context of selection and partial verification bias. Early CT can miss duct injury, and repeat CT should be considered when clinical suspicion remains high.