Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery

Abstract

Introduction During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. Methods From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34–82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57–70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. Results All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14–23). Conclusion Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.

Colo-pancreaticoduodenectomy for Locally Advanced Colon Carcinoma- Feasibility in Patients Manifesting as Acute Abdomen

“…All their patients were relatively young and healthy without associated troublesome co-morbidities. The risks of emergent PD for non-trauma patients are usually higher than trauma cases, because these patients usually have unrecognized preoperative poor conditions and ill-controlled coexisted in ammation or organ dysfunction that resulted in a failed emergent PD (30,31,33).…”

“…On the other hand, Kausch in Germany and Whipple in USA demonstrated rst the brief techniques of PD during the early 20th century. This operation procedure is also known as the "Kausch-Whipple operation" (26) for treating neoplasms or complex injuries or diseases involving duodenum and pancreatic head (26)(27)(28)(29)(30)(31)(32)(33)(34). Recently, despite the lowered operative mortality of PD to <5%, its complication rate remains high (up to > 40% in the recent literatures) (26)(27)(28)(29)(30)(31)(32)(33)(34).…”

“…The complexity of cPD is even greater over PD, and cPD further has higher operative morbidities and mortalities . Moreover, PD performed during emergency condition also are more risky (20,(27)(28)(29)(30)(31)33). Operative mortality related to emergent PD exceeds 20 to 40% (20,(27)(28)(29)(30)(31)33).…”

“…Moreover, PD performed during emergency condition also are more risky (20,(27)(28)(29)(30)(31)33). Operative mortality related to emergent PD exceeds 20 to 40% (20,(27)(28)(29)(30)(31)33). Patient's preoperative condition and its PD etiology are important factors affecting safety issues of emergent PD (29)(30)(31)33).…”

“…We occasionally encountered such patients manifestation as life-threatening conditions of CRC. Few studies have so far reported on the emergent cPD for locally advanced CRC patients at critical acute abdominal conditions (31,32). Here, we retrospectively reviewed our patients with the aimed to evaluate the feasibility and value of emergent cPD for locally advanced CRC patients showing acute abdomen.…”