title: Emergent pancreaticoduodenectomy: a dual institution experience and review of the literature.
abstract: BACKGROUND
  Emergent pancreaticoduodenectomy (EPD) is an uncommon surgical procedure performed to treat patients with acute pancreaticoduodenal trauma, bleeding, or perforation. This study presents the experience of two university hospitals with EPD.
  
  
  METHODS
  Clinical data on EPD in trauma and nontrauma patients from 2002-2012 were extracted from the hepatopancreatobiliary surgery databases at Thomas Jefferson University and Kaunas Medical University Hospitals. Data on indications, perioperative variables, morbidity, and mortality rates were evaluated.
  
  
  RESULTS
  Ten single-stage EPD patients were identified. Five underwent a classic Whipple resection, whereas five had pylorus preservation. Seven patients had traumatic indications for pancreaticoduodenectomy: three from gunshot wounds to the abdomen and four from blunt high-energy injuries (two sustained injuries by falling from height and two by direct assaults on the abdomen). Three cases of nontrauma patients had EPD surgery for massive gastrointestinal hemorrhage. The median age of the EPD cohort was 46 y (range, 19-67 y). All 10 patients were recovered and were discharged from the hospital with a median postoperative length of stay of 24 d (range, 8-69 d). There were no perioperative mortalities.
  
  
  CONCLUSIONS
  Despite a high morbidity rate and prolonged recovery, this dual institutional review suggests that EPD can serve as a lifesaving procedure in both the trauma and the urgent nontrauma settings.
authors.affiliation: Department of Surgery, Kaunas Clinics, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: aistegulla@gmail.com.
authors.forename: Aiste
authors.initials: A
authors.lastname: Gulla
authors.forename: Wei Phin
authors.initials: WP
authors.lastname: Tan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pucci
authors.forename: Zilvinas
authors.initials: Z
authors.lastname: Dambrauskas
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
authors.forename: Kris R
authors.initials: KR
authors.lastname: Kaulback
authors.forename: Juozas
authors.initials: J
authors.lastname: Pundzius
authors.forename: Giedrius
authors.initials: G
authors.lastname: Barauskas
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Harish
authors.initials: H
authors.lastname: Lavu
mesh_terms: D000328:Adult; D000368:Aged; D004630:Emergencies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000293:injuries; D016577:Pancreaticoduodenectomy / Q000401:mortality
keywords: Emergent pancreaticoduodenectomy; Gastrointestinal hemorrhage; Pancreatic trauma