Purpose or Case Report: Accidental traumatic injuries of the pancreas are rare but dangerous. In children, blunt abdominal trauma is the most common mechanism.

The goal of this presentation is to review, through a series of cases, the diagnosis, imaging findings, classification, and management of accidental traumatic pancreatic injuries in children.

Our cases include an 18-year-old football player with traumatic pancreatitis and pseudocyst formation, a 12-year-old pinned between two vehicles who sustained a pancreatic laceration with full transection of the pancreatic duct, a 15-year-old soccer player with a pancreatic laceration and truncated duct on ERCP, and a 5-year-old boy who was run over by a car and developed shock pancreas.

Traumatic injuries, as graded by the guidelines of the American Association for the Surgery of Trauma, span a gamut including contusion, laceration, transection, duct injury, ampulla injury, and massive destruction of the pancreatic head. Complications include fistula, pancreatitis, and the development of pseudocysts. Through multiple imaging modalities - including CT, MR, MRCP, ERCP, and ultrasound – our cases illustrate many of these injuries and subsequent complications.

While nonoperative treatment of minor pancreatic injuries is widely accepted, the management of more severe pancreatic injuries, such as those involving the pancreatic duct, is more controversial. Duct injury, for example, has been reported to be predictive of failure of non-operative management.

The radiologist, therefore, has the opportunity to play a pivotal role in patient care by characterizing the injury. Pancreatic organ and duct injuries can be subtle and correlation with multiple modalities as well as multidisciplinary discussion between the radiologist, surgeon, and gastroenterologist, are often required.
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