Non-operative management algorithm in a case of grade II pancreatic, grade IV splenic, and renal injury due to blunt abdominal trauma

Blunt abdominal trauma most often results from high-energy mechanisms such as motor vehicle accidents. The spleen and kidneys are the organs most commonly injured in such cases, whereas pancreatic injuries are rare. Concomitant involvement of the pancreas along with splenic and renal injuries is particularly uncommon. We report the successful non-operative management (NOM) of a 24-year-old male patient who sustained grade IV splenic and left renal injuries, a grade II pancreatic injury, and widespread pulmonary contusions following a motorcycle accident. During follow-up, expansion of the retroperitoneal hematoma, perisplenic fluid collection, and left-sided pleural effusion were observed. Interventional radiology procedures, including abdominal and thoracic drainage, were performed. The presence of high levels of amylase and lipase in the abdominal catheter output indicated the development of a pancreatic fistula, for which conservative treatment was initiated. Following catheter repositioning and administration of a somatostatin analogue, the fistula resolved spontaneously. Although left renal atrophy was detected on long-term follow-up, the patient remained clinically stable. This case highlights that even in the presence of multiple high-grade solid organ injuries, favorable outcomes may be achieved without surgical intervention through NOM. Supported by advanced imaging modalities and interventional radiology, NOM represents a safe and effective therapeutic strategy that can minimize surgical complications in hemodynamically stable patients.