THE pancreas is so well protected from nonpenetrating trauma that it is affected in less than I per cent of all closed abdominal injuries (Clarke, 1954; Allen and Curry, 1957) and is seldom damaged even by severe crushing. On occasion, however, it alone is involved, and these cases of isolated injury seem to fall into a special category. The causative blow is often slight in proportion to the glandular injury, which varies from a localized contusion to complete transverse rupture, and symptoms are typically slow to appear and deceptively mild. Many of the minor degrees of injury undoubtedly escape recognition because they never come to laparotomy, and others are diagnosed only in retrospect when a pseudocyst makes its appearance; but complete rupture is a serious injury that ends fatally if operation is too long delayed. Fortunately it is rare. It was first described i n association with other visceral injuries by Travers i n 1827, but the first example of complete rupture as a n isolated lesion occurring after non-penetrating trauma was reported by Jaun (1856) and only 19 others have been recorded since (Table I ) .
T w o cases are reported here. One is the twentyfirst example of a complete rupture, successfully treated by immediate resection of the distal fragment -a method hitherto seldom used. In the second case, in addition to some of the better-known complications, duodenal obstruction added to the difficulties. Together these cases illustrate many of the problems of diagnosis and treatment of these rare and remarkable injuries.
CASE REPORTS
Case I .-Complete transverse rupture-immediate distal pancreatectomy-uneventful recovery.
P. M., a man aged 22 years, was kicked in the belly a few minutes before the end of a game of football. He was not winded, and after a moment of intense pain was able to walk off the field, wash, change, and make his own way home. Three hours later he walked into King George V Hospital, Ilford, complaining of abdominal discomfort.
O N EXAMINATION.-At 7 p.m., no bruising could be found, and in the abdomen, which moved well with respiration, there was neither tenderness nor guarding, and bowel-sounds were clearly heard. Rectal examination was normal. He was kept under observation and after an hour the only significant change in his condition was the