Blunt Pancreatic Trauma in the ED: Systematic Review, Meta-analysis, and a Contemporary Care Algorithm
Abstract:
Background: Blunt pancreatic trauma is a rare but clinically significant entity, representing 1–5% of all abdominal injuries. Despite this low frequency, it carries substantial morbidity and mortality, particularly in cases involving main pancreatic duct (MPD) disruption. Early recognition is hindered by nonspecific symptoms and initially normal serum amylase/lipase.
Objective: To review the current literature regarding epidemiology, mechanisms, diagnostic strategies, management approaches, and outcomes of blunt pancreatic rupture, emphasizing implications for emergency physicians.
Methods: A narrative review was performed through PubMed, Cochrane, and guideline repositories (AAST, EAST, WTA, WSES), including studies from 2000–2025. Priority was given to systematic reviews, multicenter studies, and guidelines published ≥2020.
Results: Blunt pancreatic trauma accounts for approximately 1–5% of all abdominal injuries, with the highest prevalence observed in young adults. Motor vehicle collisions remain the leading cause, responsible for nearly 60% of cases, followed by falls (20%) and high-energy sports trauma (10%). Reported in-hospital mortality ranges from 10% to 20% but increases to up to 30% when pancreatic injury is associated with concomitant vascular, hepatic, or duodenal trauma.
Conclusion: Blunt pancreatic rupture, though uncommon, requires high suspicion in emergency settings. Timely imaging, ERCP when feasible, and individualized strategies are essential to reduce morbidity and mortality.
