title: Emergency pancreatoduodenectomy in nontrauma patients.
abstract: BACKGROUND
  In recent years, the safety of pancreatoduodenectomy has improved, with a low mortality rate and reduced morbidity in institutions with extensive experience in the procedure. The indication for pancreatoduodenectomy has been expanded. Emergency pancreatoduodenectomy has mainly been performed for abdominal trauma.
  
  
  OBJECTIVE
  To discuss possible indications for emergency pancreatoduodenectomy in nontrauma patients.
  
  
  METHODS
  A series of 417 consecutive pancreatic head resections performed between November 1993 and August 2000 was reviewed for emergency interventions. Indications and outcome of emergency pancreatoduodenectomies were analyzed.
  
  
  RESULTS
  The prevalence of emergency pancreatoduodenectomy was 1%. Two patients had duodenopancreatic complications after endoscopic and surgical interventions, and two patients had otherwise uncontrollable bleeding from a penetrating duodenal ulcer and an ampullary tumor. In all four patients, emergency pancreatoduodenectomy was carried out without local complications but with a high morbidity. One patient died after surgery.
  
  
  CONCLUSIONS
  We conclude that emergency pancreatoduodenectomy may be considered, under exceptional circumstances, by surgeons experienced in pancreatic resections, but unfavorable perioperative conditions should be included in the preoperative planning and risk assessment of such patients.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Bern, Switzerland.
authors.forename: Kaspar
authors.initials: K
authors.lastname: Z'graggen
authors.forename: Oliver
authors.initials: O
authors.lastname: Strobel
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.forename: Arthur
authors.initials: A
authors.lastname: Zimmermann
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D014670:Ampulla of Vater / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D004379:Duodenal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004381:Duodenal Ulcer / Q000601:surgery; D004638:Emergency Treatment; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000601:surgery; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000293:injuries / Q000473:pathology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D019512:Pancreatitis, Alcoholic / Q000150:complications