Emergency pancreatoduodenectomy for complex injuries of the pancreas and duodenum.
BACKGROUND
This single-centre study evaluated the outcome of a pancreatoduodenectomy for Grade 5 injuries of the pancreas and duodenum.


METHODS
Prospectively recorded data of patients who underwent a pancreatoduodenectomy for trauma at a Level I Trauma Centre during a 22-year period were analysed.


RESULTS
Nineteen (17 men and 2 women, median age 28 years, range 14-53 years) out of 426 patients with pancreatic injuries underwent a pancreatoduodenectomy (gunshot n = 12, blunt trauma n = 6 and stab wound n = 1). Nine patients had associated inferior vena cava (IVC) or portal vein (PV) injuries. Five patients had initial damage control procedures and underwent a definitive operation at a median of 15 h (range 11-92) later. Twelve had a pylorus-preserving pancreatoduodenectomy (PPPD) and 7 a standard Whipple. Three patients with APACHE II scores of 15, 18, 18 died post-operatively of multi-organ failure. All 16 survivors had Dindo-Clavien grade I (n = 1), grade II (n = 7), grade IIIa (n = 2), grade IVa (n = 6) post-operative complications. Factors complicating surgery were shock on admission, number of associated injuries, coagulopathy, hypothermia, gross bowel oedema and traumatic pancreatitis.


CONCLUSIONS
A pancreatoduodenectomy is a life-saving procedure in a small cohort of stable patients with non-reconstructable pancreatic head injuries. Damage control before a pancreatoduodenectomy will salvage a proportion of the most severely injured patients who have multiple injuries.
Surgical Gastroenterology, University of Cape Town, Cape Town, South Africa; HPB Surgical Unit, University of Cape Town, Cape Town, South Africa; Department of Surgery, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.
Jake E
JE
Krige
Andrew J
AJ
Nicol
Pradeep H
PH
Navsaria
D018806:APACHE; D000293:Adolescent; D000328:Adult; D004386:Duodenum / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010179:Pancreas / Q000293:injuries / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D013019:South Africa; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult