Emergency pancreatoduodenectomy for complex injuries of the pancreas and duodenum. Issue 11 (19th May 2014)

• Record Type: Journal Article
• Authors: Krige, Jake E.; Nicol, Andrew J.; Navsaria, Pradeep H.
• Is Part Of: HPB. Volume 16:Issue 11(2014:Nov.)
• Page Start: 1043
• Page End: 1049
• Publication Date: 2014-05-19
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12244
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: This single‐centre study evaluated the outcome of a pancreatoduodenectomy for Grade 5 injuries of the pancreas and duodenum. Methods: Prospectively recorded data of patients who underwent a pancreatoduodenectomy for trauma at a Level I Trauma Centre during a 22‐year period were analysed. Results: Nineteen (17 men and 2 women, median age 28 years, range 14–53 years) out of 426 patients with pancreatic injuries underwent a pancreatoduodenectomy (gunshot n = 12, blunt trauma n = 6 and stab wound n = 1). Nine patients had associated inferior vena cava (IVC) or portal vein (PV) injuries. Five patients had initial damage control procedures and underwent a definitive operation at a median of 15 h (range 11–92) later. Twelve had a pylorus‐preserving pancreatoduodenectomy (PPPD) and 7 a standard Whipple. Three patients with APACHE II scores of 15, 18, 18 died post‐operatively of multi‐organ failure. All 16 survivors had Dindo‐Clavien grade I ( n = 1), grade II ( n = 7), grade IIIa ( n = 2), grade IVa ( n = 6) post‐operative complications. Factors complicating surgery were shock on admission, number of associated injuries, coagulopathy, hypothermia, gross bowel oedema and traumatic pancreatitis. Conclusions: A pancreatoduodenectomy is a life‐saving procedure in a small cohort of stable patients with non‐reconstructable pancreatic head injuries. Damage control before a pancreatoduodenectomy will salvage a proportion of the most severely injured patients who have multiple injuries.