Pancreatic transection from blunt trauma associated with vascular and biliary lesions: a case report.
Major injuries of the pancreas may result in considerable morbidity and mortality when associated with vascular and visceral injuries. In such cases, a right diagnosis and a prompt surgical intervention are necessary to give a chance to the patient. We herein describe a case of blunt abdominal trauma in a 29-year-old man whose pancreatic rupture was associated with hepatic artery, splenic vein and extrahepatic bile duct damage. Immediate surgery was performed after computer tomograghy (CT), the haemorrhagic lesions dictat the emergency transfer to the operating room. Spleno-pancreatic resection was done with reconstruction of the hepatic artery, ligation of the splenic vein and a Roux-en-Y bilio-jejunal diversion. The early post-operative course was complicated by stenosis of the arterial reconstruction, which was treated by endovascular angioplasty followed by percutaneous drainage of symptomatic pseudocyst, rest and antibiotics. Finally, the patient was discharged and was alive without clinical problems at the time when we wrote this case report. The present case underlines the clinical relevance of vascular and visceral injuries associated with pancreatic trauma and the problems arising in the diagnostic evaluation and the surgical strategy of complex multiple visceral and vascular lesions in blunt abdominal trauma.
Baiocchi
Gian Luca
GL
Surgical Clinic, Department of Medical and Surgical Sciences, Spedali Civili di Brescia P.le Spedali Civli, 1, Brescia 25123, Italy. baioksurg@hotmail.com
Tiberio
Guido-Am
GA
Gheza
Federico
F
Gardani
Marco
M
Cantù
Massimiliano
M
Portolani
Nazario
N
Giulini
Stefano Maria
SM
D000328:Adult; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011788:Quality of Life; D012086:Reoperation; D012421:Rupture; D013162:Splenic Vein / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery