Motor vehicle collisions (e.g., steering wheel compression against the spine).
Bicycle handlebar injuries (classic presentation in pediatric patients).
Direct blows to the epigastrium (e.g., assaults, sports).
Anatomic vulnerability: Pancreas is compressed against the vertebral column.
Retroperitoneal location often delays diagnosis, leading to high morbidity.
Clinical Features
Epigastric pain that classically radiates to the back.
Nausea, persistent vomiting, and abdominal distension.
Delayed peritoneal signs (takes hours to days as pancreatic enzymes leak and cause chemical peritonitis). c
The pancreas is a retroperitoneal organ. Initial ductal leakage and hemorrhage are confined to the retroperitoneal space, which buffers early peritoneal signs and limits rapid systemic shock.
Flank/umbilical ecchymosis (Grey Turner and Cullen signs) are rare and delayed.