A 34-year-old man admitted to our department with complex blunt pancreaticoduodenal injury after a car accident. The wall of the first, second, and third portions of the duodenum was extensively lacerated, and the pancreas was longitudinally transected along the superior mesenteric vein-portal vein trunk. The pancreatic head and the uncinate process were devitalized and the distal common bile duct and the proximal main pancreatic duct were completely detached from the Vater ampulla. The length of the stump of distal common bile located at the cut surface of remnant pancreas was approximately 0.6 cm. A simplified Kausch-Whipple's procedure was performed after debridement of the devitalized pancreatic head and resection of the damaged duodenum in which the stump of distal common bile duct and the pancreatic remnant were embedded into the jejunal loop. Postoperative wound abscess appeared that eventually recovered by conservative treatment. During 16 months follow-up the patient has been stable and healthy. A simplified pancreaticoduodenectomy is a safe alternative for the Whipple procedure in managing complex pancreaticoduodenal injury in a hemodynamically stable patient.
Accidents, Traffic ; Adult ; Duodenum ; injuries ; Humans ; Male ; Pancreas ; injuries ; Pancreaticoduodenectomy ; methods ; Wounds, Nonpenetrating ; surgery

OBJECTIVETo explore the significance of damage control surgery (DCS) in the treatments of severe pancreaticoduodenal injuries.

METHODSClinical data of 19 patients with severe pancreaticoduodenal injuries managed with DCS approach in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine and the First Affiliated Hospital of Wenzhou Medical College from March 2005 to January 2013 were analyzed retrospectively.

RESULTSThree cases were cured after damage control operation and postoperative ICU resuscitation treatment. Twelve cases underwent definite operations (distal pancreaticojejunal Roux-en-Y anastomosis, proximal duodenojejunal Roux-en-Y anastomosis or pancreaticoduodenectomy) after damage control operation and postoperative ICU resuscitation treatment and cured. Four cases died after damage control operation due to multiple organ failure and the mortality was 21.1%.

CONCLUSIONApplication of DCS approach can improve the prognosis of patients with severe pancreaticoduodenal injuries.

Adult ; Duodenum ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; injuries ; surgery ; Pancreaticoduodenectomy ; Retrospective Studies ; Young Adult

OBJECTIVETo present a batch of data of transected pancreatic neck injuries and to sum up the experience in surgical interventions for the injuries.

METHODSWe analysed 13 patients with a transected injury to the pancreatic neck from Jan. 1995 to Dec. 2000. External drainage was performed in all patients. Pancreatoduodenectomy was conducted in 2 patients with a transected injury to the pancreatic neck associated with duodenal ruptures, and TPN was administered immediately after operation. Proximal closure of the transected margin and distal pancreaticojejunostomy was performed in 4 patients. Proximal closure of the transected margin and distal pancreaticojejunostomy plus splenectomy was performed in 7 patients associated with contusion of pancreatic body or tail plus spleen rupture.

RESULTS12 patients healed and one patient died of anesthetic accident during the course of restoration of the dislocation of his right hip joint. Complications occurred in 7 patients.

CONCLUSIONSThe operation should be performed according to the degree of the injuries and associated duodenal injuries. Routine drainage and nutrient support should be recommended.

Adolescent ; Adult ; Child ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Nutritional Support ; Pancreas ; injuries ; surgery

The aim of this study was to identify factors that predict morbidity and mortality in patients with traumatic pancreatic injuries. A retrospective review was performed on 75 consecutive patients with traumatic pancreatic injuries admitted to the Emergency Medical Center at Masan Samsung Hospital and subsequently underwent laparotomy during the period January 2000 to December 2005. Overall mortality and morbidity rates were 13.3% and 49.3%, respectively. A multivariate regression analysis revealed that greater than 12 blood transfusions and an initial base deficit of less than -11 mM/L were the most important predictors of mortality (p<0.05). On the other hand, the most important predictors of morbidity were surgical complexity and an initial base deficit of less than -5.8 mM/L (p<0.01). These data suggests that early efforts to prevent shock and rapidly control of bleeding are most likely to improve the outcome in patients with traumatic pancreatic injuries. The severity of pancreatic injury per se influenced only morbidity.
Adult ; Blood Transfusion ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Pancreas/*injuries/surgery ; Prognosis ; Retrospective Studies ; Wounds and Injuries/mortality

Adult ; Cystadenoma, Serous ; surgery ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Insulinoma ; surgery ; Male ; Middle Aged ; Pancreas ; injuries ; surgery ; Pancreatic Neoplasms ; surgery ; Splenic Artery ; surgery ; Splenic Vein ; surgery

OBJECTIVETo summarize the management of pancreatic injuries after blunt abdominal trauma.

METHODSThe clinical data of 42 patients with blunt pancreatic injury admitted from January 2001 to December 2010 was analyzed retrospectively. There were 38 male and 4 female patients, aging from 13 to 65 years with a mean of 31 years. The organ injury scaling of Committee of the American Association for the Surgery of Trauma (AAST grade): grade I in 3 patients, grade II in 12 patients, grade III in 9 patients, grade IV in 13 patients and grade V in 5 patients. The mean injury severity score was 27 ± 21. Patients above AAST grade II underwent peritoneal drainage and "three neostomy" (gastrostomy, jejunostomy and gallbladder) according to damage control theory.

RESULTSThirty-eight patients got abdominal CT scanning with a positive rate of 79.9% (30/38). Forty patients underwent surgical procedures, and 2 patients with non-operative management. The surgical procedures include peritoneal drainage and "three neostomy" in 32 patients, pancreas suture or pancreatic tail resection in 6 patients, pancreatoduodenectomy or caudal pancreaticojejunostomy in 2 patients. Forty patients (95.2%) survived, 2 patients (4.8%) died and 16 patients (38.1%) had complications such as pancreatic fistula,pulmonary infection.

CONCLUSIONSAbdominal CT scanning will benefit the preoperative diagnosis of blunt pancreatic trauma. Although the survival rate of patients with blunt pancreatic trauma might be improved by using the damage control surgery, the management of damage control surgery also needs to be modified because of the high rate of complications.

Adolescent ; Adult ; Aged ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; injuries ; surgery ; Retrospective Studies ; Wounds, Nonpenetrating ; surgery ; Young Adult