Multimodality imaging of a paediatric pancreatic fracture.

To cite: Neelakantan S, Jose W, Cicilet S, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016215708 DESCRIPTION A 13-year-old boy presented to the emergency department, with a history of blunt abdominal trauma. On examination, epigastric tenderness with regional guarding was noted. His vitals were stable. An initial screening transabdominal ultrasound showed a linear fracture (parenchymal disruption) of the pancreatic neck with minimal peripancreatic fluid (figure 1). Contrast-enhanced CT of the abdomen showed the fracture extending anteroposteriorly with minimal peripancreatic fluid. There was no other associated visceral injury (figures 2–4). An MRI with MR cholangiopancreatography (MRCP) was performed 2 days later, which confirmed pancreatic duct disruption and showed the peripancreatic fluid collection tracking along the posteromedial aspect of the liver (figures 5–8). The patient was classified as having grade III pancreatic injury as per the American Association for the Surgery of Trauma (AAST) classification. The patient underwent surgical intervention. Blunt abdominal trauma rarely results in pancreatic fracture (<2% cases) by virtue of the pancreas being protected in its retroperitoneal location. When present, pancreatic fractures are associated with high morbidity and mortality. This is especially true when the diagnosis is delayed and in the presence of associated ductal injury. Symptoms