Case Study of a Pancreatic Head Lesion in an Adolescent Women following Abdominal Trauma

Abstract

Pancreatic trauma is rare with an increased incidence in pediatric patients. Pancreatic lesions identified following pancreatic trauma may be sequela of the trauma or incidental of the trauma.² Walled off Pancreatic Necrosis (WOPN) is a collection that persists following acute pancreatitis appearing sonographically as a heterogeneous, mixed cystic solid lesion with an echogenic capsule. Solid Pseudopapillary Epithelial Neoplasm (SPEN) are a rare tumour of the pancreas most commonly diagnosed in young women. SPEN has a lack of specific signs and symptoms leading to identification incidentally secondary to abdominal trauma, or other health screening. This article presents the case study of a 12-year-old southeast Asian female who presented to the hospital following recent abdominal trauma. Ultrasound imaging identified a large mass in the pancreatic head, sonographically described as a heterogeneous cystic-solid lesion with an echogenic capsule. Given the clinical presentation of recent abdominal trauma and a sonographically heterogeneous intratumoural area, the primary diagnosis suggested a complication from the pancreatic trauma; hematoma or WOPN. Sonographic features and clinical presentation also positively correlated with the differential diagnosis of a neoplastic lesion, SPEN. Further investigation was done with MRI, blood analysis and biopsy to attempt to diagnose the etiology of the lesion with non-diagnostic results. Ultrasound was used to monitor the lesion because it is a safe and reliable imaging modality in the pediatric patient. Sonography showed a change in pancreatic echogenicity – correlated with blood work to be pancreatitis - followed by resolution of the pancreatic head lesion. Therefore the lesion is diagnosed as a complication of pancreatic trauma, walled off pancreatic necrosis.