Pankreas yaralanması

Özet

Epigastrik künt darbe sonrası pankreas yaralanması erken BT’de silik olabilir; yaralanma baş, gövde veya kuyrukta görülebilir. IV kontrastlı BT, parankim kesintisini, çevre dokudaki kanama ve sıvıyı, ayrıca eşlik eden damar veya duodenum hasarını haritalamak için ilk incelemedir. Ana pankreatik kanal BT'de her zaman seçilmediğinden, derin yarık kanal hasarı olasılığını artırsa da normal görünen kanal bunu dışlamaz. Hasarın gözden kaçması duktal kaçak, fistül ve geç koleksiyonların tanınmasını geciktirebilir.

Faz ve pencere

Portal tanısal

Pankreas parankimindeki kontüzyon, kontrastlanma azalması veya laserasyon; pankreas çevresi ve ön pararenal alandaki sıvı portal venöz fazda belirginleşir. Yarığın derinliğini ve pankreas parankimindeki yayılımını gösterin; parankimin yarısından fazlasını tutan laserasyon kanal yaralanmasını düşündürür.

Arteriyel tanısal

Kanama kuşkusu varsa kontrastlı BT’de eşlik eden damar yaralanmaları araştırılır.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40), Anjiyo (G 600 / M 150).

BT bulguları

• Parankimal kontüzyon — bezde fokal şişme veya heterojen kontrastlanma; çevre yağ dokusunda hafif ödem görülebilir.
• Pankreatik laserasyon — pankreas dokusunu kesen düşük atenüasyonlu yarık; derinliği ve bezin karşı yüzüne ulaşıp ulaşmadığı çok düzlemli kesitlerde izlenir.
• Transeksiyon — parankim sürekliliğinin kaybı, iki bez ucu arasında aralık veya sıvı ve yarığın boyun-gövde düzeyindeki komşu damarlarla ilişkisi.
• Ana kanal hasarı kuşkusu — derin parankim yarığı veya tam kat kesinti; kanalın BT'de doğrudan görülmemesi duktal yaralanmayı dışlamaz.
• Peripankreatik sıvı — pankreas çevresinde, özellikle bez ile splenik ven arasında ya da ön pararenal alanda yeni sıvı ve yağ planlarında bulanıklık.
• Vasküler veya komşu organ yaralanması — pankreas çevresinde aktif kontrast kaçağı, splenik damar/portal ven-SMV hasarı ya da pankreas başı komşuluğunda duodenum duvarı bozukluğu.

Ölçütler ve sınıflamalar

AAST Pankreas Organ Yaralanma Ölçeği, 2024 revizyonu

Normalde

Normal pankreasta baş, uncinate çıkıntı, boyun, gövde ve kuyruk kesitler boyunca birbirine devam eder; bezin kontrastlanması çevre yumuşak dokuyla belirgin biçimde ayrışır. Yaralanma kuşkulu kesitte bez konturunda ve parankim dokusunda sürekliliği, ayrıca splenik ven ile portal ven-SMV birleşiminin kesintisiz seyrini komşu aksiyel ve koronal kesitlerle karşılaştırın.

Ayırıcı tanı

Travmatik pankreatit

bezde yaygın ödem ve çevre sıvı oluşturabilir; odaksal parankim yarığı veya doku süreksizliği gösterilmemesi yaralanma hattından ayırır.

Pankreatik psödokist

düzgün sınırlı sıvı koleksiyonudur; akut dönemde duvarı ince olabilir, ancak bez içinden geçen yeni yarık görünümü beklenmez.

Tuzaklar

• Travmadan kısa süre sonra yapılan BT'de bezdeki belirgin değişiklikler henüz gelişmemiş olabilir; baş-boyun hattındaki ince yarığı ve çevresindeki yeni sıvıyı ardışık kesitlerde arayın.
• Tek aksiyel kesitteki ince pankreatik yaralanma erken BT’de gözden kaçabilir; yaralanmanın zamanla belirginleşebilmesi nedeniyle ardışık BT veya MR görüntülemesi önemlidir.
• Pankreas çevresindeki sıvı kanalın koptuğunu kanıtlamaz; raporda görüntülenen yarığı ve kanalın doğrudan değerlendirilemediği durumdaki belirsizliği ayrı ifade edin.
• Pankreas başı yakınındaki retroperitoneal gaz veya sıvı duodenum yaralanmasından kaynaklanabilir; duodenum duvarını ve lümen dışı gazın merkezini takip edin.

Kendini dene

1. Künt epigastrik darbe sonrası BT’de pankreas parankiminin yarısından fazlasını tutan laserasyon görülüyor; ana kanal seçilemiyor. En önemli eşlik eden şüphe hangisidir?

   • Ana kanal yaralanması
   • Pankreatik kontüzyon
   • Pankreas içi hematom
   • Normal lobülasyon
   Cevabı göster

   Ana kanal yaralanması. Parankimin yarısından fazlasını tutan laserasyon BT’de kanal yaralanmasını düşündürür; BT kanal hasarını doğrudan göstermekte yetersiz kalabilir. Pankreas travmasının BT bulguları özgül olmayabilir; laserasyon, transeksiyon, büyümüş pankreas, heterojen kontrastlanma ve peripankreatik sıvı görülebilir.

2. Travma sonrası BT’de pankreas çevresinde sıvı görülüyor, ancak parankim kesintisi izlenmiyor; bu bulgu tek başına kanal yaralanmasını kanıtlar mı? En uygun morfolojik yorum hangisidir?

   • Pankreatik kontüzyon/ödem
   • Pankreas transeksiyonu
   • İntrapankreatik hematom
   • Ana kanal kopması
   Cevabı göster

   Pankreatik kontüzyon/ödem. Parankim konturu korunurken ödem ve heterojenite kontüzyon/ödem görünümünü destekler. BT’de pankreas travması bulguları özgül olmayabilir; kanal yaralanması BT’de gözden kaçabilir ve kanal bütünlüğü belirsizse MRCP veya ERCP ile değerlendirilebilir.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Beyond the Six-Week Rule: Contemporary Insights Into Pancreatic Pseudocystpmc.ncbi.nlm.nih.gov
2. Investigating Immune Checkpoint Inhibitor-Induced Pancreatic Injury: When to Discontinue Cancer Therapypmc.ncbi.nlm.nih.gov
3. The Metabolic Legacy of Acute Pancreatitis: Post-Pancreatitis Diabetes Mellituspmc.ncbi.nlm.nih.gov
4. Type 3 Autoimmune Pancreatitis: What Do We Know So Far?pmc.ncbi.nlm.nih.gov
5. Redefining pancreatogenic diabetes mellitus through molecular, imaging, and AI-driven evidencepmc.ncbi.nlm.nih.gov
6. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines.pubmed.ncbi.nlm.nih.gov
7. Pancreatic trauma.pubmed.ncbi.nlm.nih.gov
8. Iatrogenic hepatopancreaticobiliary injuries: a review.pubmed.ncbi.nlm.nih.gov
9. Blunt pancreatic injury in children.pubmed.ncbi.nlm.nih.gov
10. Management of splenic and pancreatic trauma.pubmed.ncbi.nlm.nih.gov
11. Type 3 autoimmune pancreatitis (immune checkpoint inhibitor-induced pancreatitis).pubmed.ncbi.nlm.nih.gov
12. Management of blunt pancreatic trauma in children.pubmed.ncbi.nlm.nih.gov
13. Imaging of Pancreatic and Duodenal Trauma.pubmed.ncbi.nlm.nih.gov
14. Imaging of Blunt Pancreatic Trauma: A Systematic Review.pubmed.ncbi.nlm.nih.gov
15. Blunt pancreatic trauma: A persistent diagnostic conundrum?pubmed.ncbi.nlm.nih.gov
16. Evolving management of pancreatic injury.pubmed.ncbi.nlm.nih.gov
17. Clinical update on management of pancreatic trauma.pubmed.ncbi.nlm.nih.gov
18. Early endoscopic treatment of blunt traumatic pancreatic injury.pubmed.ncbi.nlm.nih.gov
19. Immune Checkpoint Inhibitor-Induced Pancreatic Injury: Imaging Findings and Literature Review.pubmed.ncbi.nlm.nih.gov
20. Rapid Interval Development of a Left Hepatic Artery Pseudoaneurysm During Acute Interstitial Edematous Pancreatitis.pubmed.ncbi.nlm.nih.gov
21. Atraumatic Splenic Rupture Caused by Splenic Vein Thrombosis in a Patient With Chronic Pancreatitis.pubmed.ncbi.nlm.nih.gov
22. A modified stent-free Chen's U-suture technique in pediatric pancreaticojejunostomy: safety and efficacy.pubmed.ncbi.nlm.nih.gov
23. Artificial Intelligence-Based Prediction of Pancreatic Stone Clearance in Pancreatolithiasis Using Pretreatment CT Images and Clinical Features.pubmed.ncbi.nlm.nih.gov
24. Imaging-Based Risk Stratification of IPMN Using a Structured Imaging Score: A Retrospective Proof-of-Concept Study.pubmed.ncbi.nlm.nih.gov
25. Severe cerebral injury secondary to an air embolism following ERCP for biliary calculus extraction: a case report.pubmed.ncbi.nlm.nih.gov
26. Spontaneous choledochoduodenal fistula following complete common bile duct transection from penetrating abdominal trauma: an unexpected non-operative resolution.pubmed.ncbi.nlm.nih.gov
27. Surgical and functional outcomes of pediatric pancreatic solid pseudopapillary neoplasm: A retrospective study.pubmed.ncbi.nlm.nih.gov
28. A 27-Year-Old Man with Chronic Traumatic Pancreatic Fistula Managed with Percutaneous Microwave Ablation.pubmed.ncbi.nlm.nih.gov
29. Assessing Pancreatic Enhancement Variability in ICU Patients with CT Hypoperfusion Complex: A Retrospective Single-Center Study.pubmed.ncbi.nlm.nih.gov
30. Boerhaave Syndrome Caused by Pancreatitis-Induced Gastric Outlet Obstruction: A Case Report.pubmed.ncbi.nlm.nih.gov
31. Safety and Efficacy of Double-Layer Pancreaticojejunostomy With a Wide Jejunal Opening: Initial Experience From a Consecutive Case Series.pubmed.ncbi.nlm.nih.gov
32. A more radical perspective on surgical approach and outcomes in pancreatic cancer-a narrative review.pubmed.ncbi.nlm.nih.gov
33. Abdominal vascular hemorrhage.pubmed.ncbi.nlm.nih.gov
34. Pitfall in necrotizing pancreatitis: Organized hematoma with arteriovenous fistula mimicking a splenic artery pseudoaneurysm.pubmed.ncbi.nlm.nih.gov
35. Iatrogenic portobiliary fistula treated with covered stent following percutaneous transhepatic biliary drainage.pubmed.ncbi.nlm.nih.gov
36. Discordance between CECT and angiographic findings in severe acute pancreatitis-related hemorrhage: implications for interventional management.pubmed.ncbi.nlm.nih.gov
37. Current State of Imaging of Pediatric Pancreatitis: AJR Expert Panel Narrative Review.pubmed.ncbi.nlm.nih.gov
38. Imaging of inflammatory disease of the pancreas.pubmed.ncbi.nlm.nih.gov
39. Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma.pubmed.ncbi.nlm.nih.gov
40. Computed tomography of pediatric abdominal trauma: optimizing utilization and enhancing diagnostic interpretation.pubmed.ncbi.nlm.nih.gov
41. Multimodality diagnostic imaging and role of interventional radiology in pancreas transplantation.pubmed.ncbi.nlm.nih.gov
42. Renal trauma imaging: Diagnosis and management. A pictorial review.pubmed.ncbi.nlm.nih.gov
43. A Study on the Spectrum of Imaging Findings of Post-ERCP-Specific Complications: A Retrospective Descriptive Study.pubmed.ncbi.nlm.nih.gov
44. Emphysematous pancreatitis with pulmonary embolism: A case report.pubmed.ncbi.nlm.nih.gov
45. Ruptured Pseudoaneurysm of Right Hepatic Artery as Immediate Complication of Lumen-Apposing Metal Stent Placement for Choledochoduodenostomy: A Case Report.pubmed.ncbi.nlm.nih.gov
46. Endoscopic Ultrasound as a Diagnostic Tool in Obscure Gastrointestinal Bleeding: Left Gastric Artery Pseudoaneurysm Mimicking Gastric Varices.pubmed.ncbi.nlm.nih.gov
47. Common cystic pancreatic neoplasms: A comprehensive magnetic resonance imaging-based review of typical and atypical imaging features.pubmed.ncbi.nlm.nih.gov
48. Necrotizing pancreatitis with multifocal hepatic artery pseudoaneurysms: Diagnostic limitations and rare appearance of suspected IgG-4 related disease.pubmed.ncbi.nlm.nih.gov
49. Updates on Imaging Assessment of Pancreatic Cancer for Determining Anatomic and Biologic Resectability.pubmed.ncbi.nlm.nih.gov
50. Comparative Outcomes of Pancreaticogastrostomy and Pancreaticojejunostomy Following Pancreaticoduodenectomy: A Retrospective Cohort Study from a Romanian High-Volume Center.pubmed.ncbi.nlm.nih.gov
51. The Gastric Vein Variants: An Evidence-Based Systematic Review of Prevalence and Clinical Considerations.pubmed.ncbi.nlm.nih.gov
52. Surgical outcome of extrahepatic portal venous obstruction: Audit from a tertiary referral centre in Eastern India.pubmed.ncbi.nlm.nih.gov
53. Splenic artery embolization for trauma: a narrative review.pubmed.ncbi.nlm.nih.gov
54. The Management of Splenic Injuries.pubmed.ncbi.nlm.nih.gov
55. Strategic Care of Ballistic Injuries: A Retrospective Observational Study at a Moroccan Military Hospital.pubmed.ncbi.nlm.nih.gov
56. Presentation and Management of High-Grade Pancreatic Injuries: Case Series.pubmed.ncbi.nlm.nih.gov
57. Severe post-traumatic Pancreatoduodenal injury with septic shock and enteric fistula: A multidisciplinary challenge - Case report.pubmed.ncbi.nlm.nih.gov
58. Blunt Pancreatic Transection With Ductal Disruption in a Stable Patient: Rethinking Surgical Necessity Through a Case-Based Review.pubmed.ncbi.nlm.nih.gov
59. Application and value of CT-based 3D surgical modeling in the robotic management of grade V pancreatic trauma and grade III duodenal injury: a case report and literature review.pubmed.ncbi.nlm.nih.gov
60. Pancreaticoduodenectomy for trauma in an adolescent female with complex pancreatic and duodenal injuries: Case report and review of the literature.pubmed.ncbi.nlm.nih.gov
61. The Diagnosis and Management of Pediatric Blunt Abdominal Trauma-A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
62. Imaging and clinical features of intra-abdominal injuries in children with suspected physical abuse.pubmed.ncbi.nlm.nih.gov
63. Duodenal Trauma: Mechanisms of Injury, Diagnosis, and Management.pubmed.ncbi.nlm.nih.gov
64. Abdominal organ injury in cardiac arrest: Systematic literature review.pubmed.ncbi.nlm.nih.gov
65. Development and Proof-of-Concept Evaluation of a Structured Reporting Template for Emergency Radiology Using Synthetic Cases.pubmed.ncbi.nlm.nih.gov
66. Pancreatic Pseudocyst Masquerading as Right Atrial Thrombus: An Unusual Intracardiac Extension.pubmed.ncbi.nlm.nih.gov
67. Walled-Off Pancreatic Necrosis Mimicking a Pancreatic Pseudocyst: A Diagnostic Pitfall With Therapeutic Implications.pubmed.ncbi.nlm.nih.gov
68. Spontaneous Bacterial Peritonitis as a Rare Complication of a Pancreatic Duct Leak in a Patient Without Cirrhosis: A Case Report.pubmed.ncbi.nlm.nih.gov
69. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
70. Schwannoma Likely Arising from the Pancreatic Head Nerve Plexus That Mimicked a Mucinous Cystic Neoplasm and Was Treated by Pancreaticoduodenectomy: A Case Report.pubmed.ncbi.nlm.nih.gov
71. A Case of Acute Pancreatitis With Fat Saponification Mimicking Carcinomatosis in an Adolescent: Is It Carcinomatosis or Fat Necrosis?pubmed.ncbi.nlm.nih.gov
72. Case Report: A rare case of gastric cardia bronchogenic cyst: diagnostic challenges and EUS findings with elevated cyst-fluid tumor markers.pubmed.ncbi.nlm.nih.gov
73. Imaging diagnosis and sequential conservative treatment of pediatric traumatic duodenal intraluminal hematoma.pubmed.ncbi.nlm.nih.gov
74. Complications and expected imaging findings after endoscopic retrograde cholangiopancreatography.pubmed.ncbi.nlm.nih.gov
75. Clinical applications of 4D flow magnetic resonance imaging in hepatic vascular disorders: practical biomarkers, protocol design, and translational implementation.pubmed.ncbi.nlm.nih.gov
76. Artificial Intelligence and 3D Reconstruction in Complex Hepato-Pancreato-Biliary (HPB) Surgery: A Comprehensive Review of the Literature.pubmed.ncbi.nlm.nih.gov
77. Mesopancreas-Anatomical Insights and Its Implications for Diagnosis and Clinical and Surgical Practice.pubmed.ncbi.nlm.nih.gov
78. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
79. Traumatic Pancreatic Injury Presentation, Management, and Outcome: An Observational Retrospective Study From a Level 1 Trauma Centre in Northern India.pubmed.ncbi.nlm.nih.gov
80. Surgical techniques for modular one-stage emergent pancreaticoduodenectomy for blunt abdominal trauma: experiences from three centres and a review of the literature.pubmed.ncbi.nlm.nih.gov
81. Case Report: Resectability-guided management of an indeterminate periduodenal spindle cell tumor initially suspected to be a gastrointestinal stromal tumor.pubmed.ncbi.nlm.nih.gov
82. Case Report: Late repeat pancreatic irreversible electroporation in the long-term multidisciplinary management of unresectable pancreatic ductal adenocarcinoma.pubmed.ncbi.nlm.nih.gov
83. Multiomics Analysis-Based Biomarkers in Diagnosis of Polycystic Ovary Syndrome.pubmed.ncbi.nlm.nih.gov
84. Commentary: an eye on PET quantification.pubmed.ncbi.nlm.nih.gov
85. Total pancreas-preserving pancreatic injury-site jejunostomy for traumatic pancreatic head injury with main pancreatic duct transection: feasibility and decision algorithm.pubmed.ncbi.nlm.nih.gov
86. Omadacycline-Associated Pancreatic Injury: a Spectrum from Mild Interstitial to Recrudescent Pancreatitis with Pharmacovigilance Implications.pubmed.ncbi.nlm.nih.gov
87. Concurrent Pancreatic and Sartorius Muscle Lipomas: A Case Report.pubmed.ncbi.nlm.nih.gov
88. Pancreatoduodenectomy and surgical treatment of groove pancreatitis.pubmed.ncbi.nlm.nih.gov
89. Case Report: Giant cystic solid aggressive fibromatosis of the pancreas: clinical and pathologic features.pubmed.ncbi.nlm.nih.gov
90. Pancreatic Morphology, Immunology, and the Pathogenesis of Acute Pancreatitis.pubmed.ncbi.nlm.nih.gov
91. Rathke's cleft cyst: From history to molecular genetics.pubmed.ncbi.nlm.nih.gov
92. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach.pubmed.ncbi.nlm.nih.gov
93. Pancreatic injury due to blunt trauma on CT: does retropancreatic fat tissue reduce the severity of pancreatic injury?pubmed.ncbi.nlm.nih.gov
94. International Society of Paediatric Surgical Oncology (IPSO) Minimally Invasive Surgery (MIS) Guidelines.pubmed.ncbi.nlm.nih.gov
95. Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit.pubmed.ncbi.nlm.nih.gov
96. Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy-Case Report and Comprehensive Literature Review.pubmed.ncbi.nlm.nih.gov
97. Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis.pubmed.ncbi.nlm.nih.gov
98. Imaging of the spleen: what the clinician needs to know.pubmed.ncbi.nlm.nih.gov
99. Updates in Pancreatic Trauma Imaging.pubmed.ncbi.nlm.nih.gov
100. Indocyanine green fluorescence-guided laparoscopic central pancreatectomy for complete pancreatic transection trauma: a rare case and literature review.pubmed.ncbi.nlm.nih.gov
101. Pancreatic stent and transpapillary pseudocyst drainage via endoscopic retrograde cholangiopancreatography for children with blunt pancreatic duct injury.pubmed.ncbi.nlm.nih.gov
102. Pediatric blunt duodenal injury: a 9-year retrospective single-center series from Vietnam.pubmed.ncbi.nlm.nih.gov
103. A diagnostic approach to the mediastinal masses.pubmed.ncbi.nlm.nih.gov
104. Periportal Right Colic Artery Arising From the Ventral Aspect of the Superior Mesenteric Artery With Associated Vascular Anomalies: A Case Report.pubmed.ncbi.nlm.nih.gov
105. Application of computer-assisted surgery system in a child with multiple traumas: a case report.pubmed.ncbi.nlm.nih.gov
106. Expert consensus on interventional therapy for traumatic splenic bleeding.pubmed.ncbi.nlm.nih.gov
107. Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience.pubmed.ncbi.nlm.nih.gov
108. Pediatric ultrasonography of the pancreas: normal and abnormal findings.pubmed.ncbi.nlm.nih.gov
109. Duodenal imaging on the spotlight: from A to Z.pubmed.ncbi.nlm.nih.gov
110. Splenic pathologies: A pictorial review of common, wandering, twisting and rare presentations.pubmed.ncbi.nlm.nih.gov
111. Successful ultrasound-guided percutaneous embolization of splenic artery pseudoaneurysm with Glubran 2 cyanoacrylate glue: A case report.pubmed.ncbi.nlm.nih.gov
112. A case of blunt liver injury with rare hemodynamics: traumatic outflow block.pubmed.ncbi.nlm.nih.gov
113. Platelet-Neutrophil Association in NETs-Rich Areas in the Retrieved AIS Patient Thrombi.pubmed.ncbi.nlm.nih.gov
114. Association of Hepatic Steatosis With Coronary Artery Disease by Studying the Role of Individual and Demographic Risk Factors.pubmed.ncbi.nlm.nih.gov
115. Rathke's cleft cyst: clinicopathological and MRI findings in 22 patients.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.