Spontaneous Pancreatic Laceration: A Rare but Lethal Entity

Spontaneous pancreatic laceration (SPL) is a rare, non-traumatic pancreatic parenchymal tear with ductal disruption. It is distinct from traumatic pancreatitis and carries high mortality if unrecognized.

Etiology & Risk Factors

• Pre-existing Pancreatic Pathology: Chronic pancreatitis, pseudocysts, pancreas divisum, neoplasm (IPMN, adenocarcinoma) — weaken parenchyma/ducts.
• Acute Precipitants: Sudden ↑ intra-abdominal pressure (violent vomiting, coughing, Valsalva, straining), blunt abdominal trauma (even minor), ERCP/sphincterotomy.
• Systemic Factors: Alcohol, steroids, hypercalcemia, hypertriglyceridemia, pregnancy (mechanical + hormonal), vascular anomalies.

Clinical Presentation

• Sudden, severe epigastric pain radiating to back.
• Nausea/vomiting, tachycardia, hypotension (hemorrhage/third-spacing).
• Peritoneal signs (rigidity, guarding) if enzymatic/hemorrhagic peritoneal irritation.
• Grey Turner's sign (flank ecchymosis), Cullen's sign (periumbilical) — late, severe.

Diagnosis

• CT Abdomen with Pancreatic Protocol (IV contrast): Parenchymal laceration, peripancreatic fluid/hemorrhage, duct disruption (extravasation on delayed phase).
• MRCP: Non-invasive ductal assessment if CT equivocal.
• Serum amylase/lipase: Elevated but non-specific.

Management

• Resuscitation: Aggressive IV fluids, analgesia, ICU monitoring.
• ERCP + Stenting: First-line for duct disruption (bridges leak, promotes healing).
• Percutaneous Drainage: For infected/organized collections.
• Surgery (Distal Pancreatectomy, Drainage, Ligation): Failed endoscopic therapy, hemodynamic instability, necrosis, hemorrhage.

Prognosis

Mortality 10–30% depending on grade (A–E, AAST), timing of intervention, and comorbidities. Early ERCP-based management improves outcomes.

SPL should be suspected in at-risk patients with acute abdomen after emesis/Valsalva—even without major trauma.