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cases, endoscopic retrograde cholangiopancreatography (ERCP) may be
performed for both diagnostic and therapeutic indications ( Fig. 103.8 ).
Severe injury of the pancreas is rare, but when it occurs, blood loss and leakage
of enzyme-laden secretions may result in hypovolemia and peritonitis. Blunt
abdominal trauma may also injure the ductal elements of the pancreas, and
diagnosis depends on a high index of suspicion, consideration of the mechanism
of injury, physical examination, serum amylase determination, and diagnostic
imaging. Of note, however, is that the absence of hyperamylasemia does not
preclude pancreatic trauma. Serum amylase level may be normal in 30% of
patients with complete transaction, whereas elevated serum amylase level is
detected in 14% to 80% of cases of blunt injury. Elevated serum amylase level
should suggest the possibility of pancreatic involvement, but the absolute value
does not correlate with the degree of injury.
Hyperamylasemia may be present with pancreatic injury, but its absence does
not preclude injury. In one study, elevations of amylase level more than 200 U/L
and lipase level more than 1,800 U/L were markers of possible major pancreatic
ductal disruption. In a more recent retrospective study, elevations of amylase and
lipase levels were infrequently detected in patients with blunt abdominal trauma
(4% and 7%, respectively), and neither the sensitivity nor negative predictive
values of elevated measurements were sufficient to be used as screening tools for
pancreatic injury. Pancreatic injury is difficult to diagnose, particularly since a CT
scan of the abdomen is only 60% to 70% accurate in identifying pancreatic injury.