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Journal of Trauma and Injury 2012;25(4):115-121.
Emergency Pancreaticoduodenectomy for Severe Pancreaticoduodenal Injury
In Kyu Park, Yoon Jin Hwang, Hyung Jun Kwon, Kyung Jin Yoon, Sang Geol Kim, Jae Min Chun, Jin Young Park, Young Kook Yun
1Department of Surgery, Kyungpook National University School of Medicine, Korea.
2Department of Surgery, Kyungpook National University Medical Center, Korea. yjhwang@knu.ac.kr
3Department of Surgery, Changwon Fatima Hospital, Korea.
췌십이지장 손상에서의 응급췌십이지장절제술
박인규∙황윤진1∙권형준1∙윤경진2∙김상걸1∙천재민∙박진영∙윤영국
경북대학교 의학전문대학원 외과학교실, 1칠곡경북대학교병원 외과, 2창원파티마병원 외과
Received: 10 September 2012   • Revised: 11 September 2012   • Accepted: 23 October 2012
Abstract
PURPOSE
Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries.
METHODS
We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations, mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed.
RESULTS
The mean age of the 16 patients was 45+/-12 years (mean+/-standard deviation), and 15(93.8%) patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than III. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple's operation, and 1 patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%), delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD.
CONCLUSION
Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be considered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries, provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable.
Key Words: Pancreaticoduodenal injury; Pancreaticoduodenectomy


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