Pancreatic injuries are occasionally overlooked in patients subjected to abdominal trauma despite it is a serious injury with high morbidity and mortality. Moreover, pancreatic injury is rare and imaging diagnosis is usually challenging especially if the CT study is limited and has done urgently with no contrast injection. As a rule of thumb, if there is a collection in the peri-pancreatic and retroperitoneal regions, the pancreatic injury should be suspected even it is not seen directly.

This case represents an example of the usual challenging situation facing radiologists in trauma patients with multiple distracting obvious findings away from the uncommon, barely visible serious pancreatic injury. The patient's serum Lipase was 6770 U/L and serum Amylase was 965 U/L. Severe pancreatic injury involving ducts was confirmed on laparotomy. The patient transferred to a higher center for a major surgical interference.