Blunt Pancreatic Transection With Ductal Disruption in a Stable Patient: Rethinking Surgical Necessity Through a Case-Based Review.

Blunt pancreatic trauma is uncommon and difficult to diagnose early due to its retroperitoneal location and vague symptoms. While high-grade injuries with ductal disruption often require surgery, selected hemodynamically stable cases may benefit from conservative management. We describe a 20-year-old woman who sustained a Grade III pancreatic transection with suspected ductal injury following blunt abdominal trauma from a horse kick. Despite a delayed diagnosis, she remained stable. Imaging with MRI and contrast-enhanced CT confirmed complete distal pancreatic transection and a nonbleeding splenic contusion. A multidisciplinary team opted for nonoperative management, including antibiotics, bowel rest, parenteral nutrition, and close monitoring. The patient recovered without complications or need for surgery. Follow-up imaging confirmed resolution without pseudocyst or abscess formation. This case supports the safety and effectiveness of conservative management in select high-grade pancreatic injuries with ductal disruption, emphasizing the importance of early imaging, multidisciplinary coordination, and tailored decision-making, especially in resource-limited settings.