Operative recognition of isolated pancreatic transection after blunt abdominal trauma in a resource-limited Tanzanian hospital: a case report
Mirko Lombardi, Bahati G Kamwezi, Giulia Lojacono, Tulia M Hadi, Lusekelo W Mwalukambwe, Shama V Mkini, Nelice S Deogratius, Agnes L MlawaAbstract
Introduction
Isolated pancreatic transection after blunt trauma is rare. A focal epigastric impact may compress the pancreas against the vertebral column, an important clue when cross-sectional imaging is unavailable.
Case Description
A 29-year-old Tanzanian man presented 4 hours after a heavy tree log struck him directly in the epigastrium. He was haemodynamically stable but had generalized peritoneal signs and free intraperitoneal fluid on E-FAST, establishing an indication for laparotomy. No major intraperitoneal injury explained the haemoperitoneum. Bloody fluid at the mesocolic root and retrogastric-retroperitoneal haemorrhagic infiltration prompted deliberate lesser-sac exploration, revealing complete pancreatic body transection extending towards the neck with splenic artery disruption and suspected splenic vein thrombosis. Distal pancreatectomy with splenectomy was performed. A postoperative biochemical leak resolved with drainage alone; at 3-month follow-up he was well and normoglycaemic.
Discussion
The focal epigastric impact was consistent with compression of the pancreatic body/neck against the vertebral column. During trauma laparotomy, unexplained retrogastric or retroperitoneal haemorrhagic infiltration should raise suspicion of occult pancreatic injury and prompt direct inspection of the lesser sac. This case complements regional tertiary-centre experience by illustrating immediate recognition and definitive treatment in a rural sub-Saharan African setting.