title: Emergency Kausch-Whipple procedure: indications and experiences.
abstract: OBJECTIVE
  Pancreaticoduodenectomy is a demanding procedure even in selected patients but becomes formidable when performed in cases of emergency. This study analyzed our experience with urgent pancreatoduodenectomies; special emphases were put on the evaluation of diagnostic means and the validation of existing indications for performance of this procedure.
  
  
  METHODS
  Three hundred one patients who underwent pancreatoduodenectomy between 1989 and 2008 were identified from a pancreatic resection database and reviewed for emergency indications.
  
  
  RESULTS
  Six patients (2%) underwent emergency pancreatoduodenectomy. Indications included endoscopy-related perforation, postoperative complications, and uncontrollable intraduodenal tumor bleeding. Length of stay and occurrence of nonsurgical complications were increased in emergency compared with elective pancreatoduodenectomies. Although increased, no significant differences were found regarding mortality and surgery-related complications.
  
  
  CONCLUSIONS
  Indications for emergency pancreatoduodenectomies were based on clinical decisions rather than on radiologic diagnostics. Urgent pancreatic head resections may be considered as an option in selected patients if handling of local complications by interventional measures or limited surgery seems unsafe.
authors.affiliation: Department of Surgery, University of Bonn Medical Center, Bonn, Germany. standop@uni-bonn.de
authors.forename: Jens
authors.initials: J
authors.lastname: Standop
authors.forename: Tim
authors.initials: T
authors.lastname: Glowka
authors.forename: Volker
authors.initials: V
authors.lastname: Schmitz
authors.forename: Nico
authors.initials: N
authors.lastname: Schaefer
authors.forename: Andreas
authors.initials: A
authors.lastname: Hirner
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Kalff
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D019992:Databases as Topic; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D012086:Reoperation; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome