title: Emergency pancreaticoduodenectomy: When is it needed? A dual non-trauma centre experience and literature review.
abstract: BACKGROUND
  Emergency pancreaticoduodenectomy (EPD) has been very rarely reported in literature as a lifesaving procedure for complex pancreatic injury, uncontrollable hemorrhage from ulcers and tumors, descending duodenal perforations, and severe infection. The aim of this study was to analyze the experience of two non-trauma centers and to review the literature concerning emergency pancreaticoduodenectomy.
  
  
  METHODS
  From January 2005 to December 2014, from a population of 169 PD (92 females and 77 males; mean age: 61.3, range 23-81) 5 patients (3%; 2 females and 3 males; mean age: 57.8, range: 42-74) underwent EPD for non-traumatic disease performed at two Academic Units of the University of Bari.
  
  
  RESULTS
  The emergency pancreaticoduodenectomy subgroup of patients showed an overall morbidity of 80%, and mortality of 40%. In 80% (4/5) of patients treated by emergency pancreaticoduodenectomy, the pancreatic remnant was not reconstructed, and in 20% (1/5) a pancreaticojejunostomy was performed.
  
  
  CONCLUSIONS
  Emergency pancreaticoduodenectomy is an effective life-saving operation reservable to pancreatoduodenal trauma, perforations, and bleeding, unmanageable by a less invasive approach. It should be preferentially approached by surgeons with a high level of experience in hepatobiliary and pancreatic surgery and in trauma centers too, but it should also be in the armamentarium of general surgeons performing hepato-pancreato-biliary surgery.
authors.affiliation: Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy. Electronic address: germana.lissidini@ieo.it.
authors.forename: Germana
authors.initials: G
authors.lastname: Lissidini
authors.affiliation: Unit of Videolaparoscopic Surgery, Department of Emergency Surgery and Organs Transplantation, University of Bari, Italy. Electronic address: pretef@gmail.com.
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Prete
authors.affiliation: Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy. Electronic address: beppestras@yahoo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Piccinni
authors.affiliation: Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy. Electronic address: angelagurrado@libero.it.
authors.forename: Angela
authors.initials: A
authors.lastname: Gurrado
authors.affiliation: Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy. Electronic address: simone.giungato@libero.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Giungato
authors.affiliation: "F.Miulli" Hospital of Acquaviva, Bari, Italy. Electronic address: pretefer@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Prete
authors.affiliation: Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy. Electronic address: mario.testini@uniba.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Testini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000293:injuries; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010193:Pancreaticojejunostomy / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Emergency pancreaticoduodenectomy; Emergency surgery; Pancreatic surgery; Pancreatic trauma; Pancreaticoduodenectomy