Pancreaticoduodenectomy for Severe Trauma to the Head of the Pancreas and the Associated Structures

Pancreatic and duodenal injuries: Keep it simple

“…There were nine late deaths; six of these were caused by sepsis and multiple organ failure (median day 6, IQR 2-39), two by ischaemic bowel (both on day two) and one by an infected aortic graft (day nine). Of the survivors, median and interquartile range of hospital stay for isolated pancreatic injuries was 8 days (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). This compares to 13 days (10-34) for duodenal injuries and 33 days (24-55) for combined injuries.…”

“…All but one of the proximal pancreatic injuries were treated with debridement of necrotic tissue and closed suction drainage. In 1969 Foley et al 8 described massive and unreconstructable injuries to the head of the pancreas, duodenum, distal common bile duct, or any combination of these structures as indications to perform pancreaticoduodenectomy (Whipple's procedure) in trauma. More recent reports suggest that Whipple's procedure is occasionally appropriate for combined American Association for the Surgery of Trauma Organ Injury Score grade V injuries of both the pancreas and duodenum.…”

Blunt pancreatic and pancreaticoduodenal trauma

“…The generally quoted mortality of 20-30 per cent is associated with severe generalized visceral injury and is much lower in pure pancreaticoduodenal injury (Foley et al, 1969;Halgrimson et al, 1969). This is borne out by the present Case 1 who did well after a pancreaticoduodenectomy.…”

“…Pancreaticoduodenectomy. The indications for this operation are not precisely defined but certainly include devitalization of either the pancreas or the duodenum (Brawley et al, 1968;Foley et al, 1969;Halgrimson et al, 1969;Northrup and Simmons, 1972;Anderson et al, 1973) because of the high mortality associated with leaving devitalized tissue in situ (Kerry and Glas, 1962).…”

Management of Pancreaticoduodenal Injuries

“…The surgical management of combined pancreaticoduodenal injuries is complex, and options vary from repair and external drainage to pancreaticoduodenectomy [30,31] described initially in 1969 by Foley et al [32] for massive and unreconstructable injuries to the head of the pancreas, duodenum, distal common bile duct or any combination of these structures. More recent reports suggest that Whipple's procedure is only occasionally appropriate for combined AAST OIS grade V injuries of both the pancreas and the duodenum [33][34][35].…”