Emergency Pancreatoduodenectomy: A Non-Trauma Center Case Series

Abstract

(1) Background: Emergency pancreatoduodenectomy (EPD) is a rare procedure, especially in non-trauma centers. Pancreatoduodenectomy is a challenging intervention, that has even higher risks in emergency settings. However, EPD can be a life-saving procedure in selected cases. (2) Methods: Our study is a single-center prospective consecutive case series, on patients that underwent emergency pancreatoduodenectomies in our surgical department between January 2014 to May 2021. (3) Results: In the 7-year period, 4 cases were operated in emergency settings, out of the 615 patients who underwent PD (0.65%). All patients were male, with ages between 44 and 65. Uncontrollable bleeding was the indication for surgery in 3 cases, while a complex postoperative complication was the reason for surgery in one other case. In three cases, a classical Whipple procedure was performed, and only one case had a pylorus-preserving pancreatoduodenectomy. The in-hospital mortality rate was 25% and the morbidity rate was 50%; the two patients that registered complications also needed reinterventions. The patients who were discharged had a good long-term survival. (4) Conclusion: EPD is a challenging procedure, rare encountered in non-traumatic cases, that can be a life-saving intervention in well-selected cases, offering good long-term survival.

A case series of emergency pancreaticoduodenectomies: What were their indications and outcomes?

“…In the literature, EPD were rarely reported, and most were case reports or case series [1][2][3][4][5][6][7][8][9][10][11][12]. In this series, EPD accounted for just 2.2% of all cases of PD.…”

“…In the literature, an EPD mortality rate of 0% to 40% was reported [1][2][3][4][5][6][7][8][9][10][11][12]. Gulla et al [6] reported a cumulative mortality rate of 29% for EPD from 1964 to 2013.…”

“…Nontraumatic causes were further classified as uncontrolled bleeding, perforation, ischemia and iatrogenic injuries. The reported mortality for EPD ranged from 0% to 40%, and the associated morbidity ranged from 50% to 80% [1][2][3][4][5][6][7][8][9][10][11][12]. Longterm outcomes of patients receiving EPD are rarely reported.…”

“…However, a study has shown that there is no difference in mortality between one-stage and two-stage EPD for hemodynamically unstable trauma patients [20]. Other authors advocate pancreaticogastrostomy (PG) for the management of pancreatic stump since in most cases of EPD the pancreas was soft with a nondilated pancreatic duct, together with the common finding of edematous jejunual wall, a duct-to-mucosa PJ would be technically demanding [3,12]. Nevertheless, the HBP surgeons in our institution performed duct-to-mucosa PJ and employed the same technique in emergency settings, and the results showed that POPF and complication rates were still acceptable.…”