Pancréatite aiguë nécrotico-hémorragique après traumatisme abdominal par arme blanche

Post-trauma acute narcotising hemorrhagic pancreatitis (ANHP) is typically reported in stamping abdominal trauma with pancreatic dilacerations or complete rupture on the spine. This complication is rarely reported in penetrating abdominal trauma with cutting weapons. We report the case of a 46-years-old man presenting with a lethal post-trauma ANHP following a penetrating abdominal injury with a wood axe. During emergency abdominal surgical exploration, superior mesenteric vein was dilacerated but pancreas was macroscopically normal. Acute pancreatitis was diagnosed 2 days after the trauma and evolved towards the patient death - by multivisceral failure - in the 20th day. Massive and severe lesions of pancreatic necrosis were observed at forensic autopsy and the diagnosis of ANHP was confirmed at pathologic examination of the gland. Moreover, no lesion of chronic pancreatitis was found. In conclusion, this case highlights that penetrating abdominal injuries with cutting weapons can be responsible of pancreatic impaction on the spine - such as in stamping trauma - due to the assailant strength and weapon weight, and can involve lethal post-trauma pancreatitis.