title: Horizontal traumatic laceration of the pancreas head: A rare case report.
abstract: BACKGROUND
  This case report is intended to inform acute care surgeons about treating rare horizontal laceration of the pancreas head caused by blunt trauma.
  
  
  METHODS
  A 57-year-old woman who sustained blunt abdominal trauma during a car crash was transported to the emergency center of our hospital with unstable vital signs due to hemorrhagic shock. Computed tomography showed transection of the pancreas head and massive intra-abdominal hemorrhage. She was referred for emergency surgery because of a transient response. Laparotomy at five hours after the accident initially revealed consistent massive bleeding from branches of the superior mesenteric artery and vein, which we resolved by suturing the vessels without damaging the main trunks. A horizontal laceration and complete transection of the pancreatic head were then confirmed but the main pancreatic duct remained intact. The lower part of the pancreatic head including the uncus with the attached part of the duodenum was resected, and the pancreatic stump remaining after transection was fixed by suturing. The jejunal limb was attached to the remnant duodenum by side-to-side functional anastomosis. Although gastric emptying was delayed for one month after surgery, the postoperative course was good and the patient recovered at three months thereafter. The embryonic border of pancreas head accompanied with pancreatic divisum was considered for this laceration without disruption of the main pancreatic duct.
  
  
  CONCLUSIONS
  Blunt pancreatic trauma usually causes vertical transection and thus, horizontal transection is considered rare. The embryological anatomical border between the ventral and dorsal pancreas due to pancreatic divisum was supposed to be transected and therefore the main pancreatic duct was not damaged.
  
  
  CONCLUSIONS
  Hemorrhagic shock and rare pancreatic head trauma were treated by appropriate intraoperative management.
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan. Electronic address: a_nanashima@med.miyazaki-u.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Imamura
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tsuchimochi
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Takeomi
authors.initials: T
authors.lastname: Hamada
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Yano
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Hiyoshi
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kawano
authors.affiliation: Division of Hepato-biliary-pancreas Surgery, Department of Surgery, Faculty of Medicine University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
authors.lastname: MitsuruTamura
keywords: Acute care surgery; Horizontal laceration; Pancreatic divisum; Pancreatic head trauma; Partial pancreatoduodenectomy