Diagnosis of pancreatic injury: a need to improve performance.

A direct frontal upper abdominal impact and a bicycle fall in a child are classical mechanisms of blunt pancreatic injury. Clinical symptoms are not characteristic. Serum amylase level is frequently normal at admission and peritoneal lavage fluid amylase is not diagnostic. CT is the most powerful imaging technique to evidence pancreatic contusion and associated injuries but remains normal or doubtful at admission in about 15% of children and 40% of adults. US is sensitive in about 70%. Both modalities are unable to detect pancreatic duct rupture. As ERP cannot be performed in all trauma patients, only patients with minor pancreatic injury can be enrolled in a conservative management without surgical revision. The role of multislice CT at admission and MRP has to be investigated to increase diagnostic efficiency in pancreatic duct injury.