Emergency pancreatoduodenectomy for complex injuries of the pancreas and duodenum

Krige, J. E. J.; Nicol, Andrew; Navsaria, Pradeep

doi:10.1111/hpb.12244

Cited by 57 publications

(81 citation statements)

References 23 publications

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“…It represents less than 2% of the total number of pancreatico-duodenectomies (5). In the majority of cases, it is performed for grade V traumatic lesions of the head of the pancreas or of the duodenum in whichlesser procedures are not possible (5). Major vascular involvement can be associated with vascular reconstruction procedures such as mesenteric vein resection and reconstruction using alloplastic patches or synthetic grafts.…”

Section: Discusionsmentioning

confidence: 99%

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft

Eftimie¹,

Lungu²,

Tudoroiu³

et al. 2017

chr

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RezumatDuodenopancreatectomia efectuatã în urgenţã este o procedurã chirurgicalã rarã şi ca urmare puţine cazuri sunt prezentate în literaturã. Este un abord folosit în puţine cazuri, fiind indicat în tratamentul chirurgical de urgenţã al traumelor abdominale ce implicã regiunea cefalopancreaticã sau duodenul, fiind şi o unealtã utilã în tratamentul anevrismelor rupte, pseudochistelor hemoragice, perforaţiilor duodenale, hemoragiei necontrolate de la nivelul ulcerelor sau tumorilor duodenale, complicaţiilor septice severe ale pancreatitei acute şi în tratamentul complicaţiilor secundare manevrelor asociate colangiopancreatografiei retrograde (1,2). Este folositã în puţine cazuri ca şi primã linie de tratament chirurgical al sângerãrilor acute datorate pseudoanevrismelor rupte ale arterelor regiunii cefalopancreatice. Prezentãm cazul unei sângerãri acute de la nivelul unui pseudoanevrism al regiunii cefalopancreatice prezent la un pacient tânãr cu pancreatitã cronicã, nediagnosticatã pânã la momentul debutului bolii şi la care s-a ridicat suspiciunea unei formaţiuni tumorale a regiunii cefalopancreatice. Am efectuat o duodenopancreatectomie cu rezecţie de venã mezentericã superioarã şi de venã portã cu reconstrucţie venoasã folosind grefon sintetic de Gore-Tex® datoritã posibilei invazii tumorale la nivel venos. Evoluţia postoperatorie a fost marcatã de apariţia unei fistule pancreatice minore, remisã sub tratament conservator. Concluzionãm cã acest abord este util în tratamentul acestor cazuri atât ca primã linie de tratament sau secundar abordului endovascular (stentare sau embolizare).Cuvinte cheie: duodenopancreatectomie cefalicã, rezecţie vascularã, rezecţie pancreaticã în urgenţã, reconstrucţie vascularã Abstract Emergency pancreatico-duodenectomy(EPD) is a very rare procedure and few reports are present in medical literature. It is an uncommon approach, usually

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Section: Discusionsmentioning

confidence: 99%

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft

Eftimie¹,

Lungu²,

Tudoroiu³

et al. 2017

chr

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“…Grade 5 injuries of the proximal pancreas with destruction of the pancreatic head are among the most devastating abdominal injuries trauma surgeons are likely to encounter [1,2]. The complexity of these critical injuries is further compounded by the consequences of associated collateral vascular damage, especially when involving the vena cava and portal venous system [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…The complexity of these critical injuries is further compounded by the consequences of associated collateral vascular damage, especially when involving the vena cava and portal venous system [1,2]. Survival is influenced by the severity of associated injuries, the magnitude and…”

Section: Introductionmentioning

confidence: 99%

“…In the small cohort of patients who have maximal injuries of the pancreatoduodenal complex and in whom there is no other rational surgical option for survival, a salvage pancreatoduodenectomy may be necessary [1,[12][13][14]. However, surgical intervention of such magnitude in those who are severely injured can only be contemplated in haemodynamically stable patients.…”

Section: Introductionmentioning

confidence: 99%

“…The concept of damage control surgery (DCS) is now an essential element in the management of severely injured patients who are haemodynamically unstable and has dramatically improved outcome [15][16][17][18]. In the largest series to date of an emergency pancreatoduodenectomy in patients with complex nonreconstructable pancreatoduodenal injuries, we reported an overall survival in 84 % [1]. However, there is a lack of accurate and robust data assessing the role of DCS in patients who have combined severe pancreatic and vascular injuries.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Damage control laparotomy and delayed pancreatoduodenectomy for complex combined pancreatoduodenal and venous injuries

Krige

Navsaria

Nicol

2015

Eur J Trauma Emerg Surg

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Pancreatic trauma with main pancreatic duct injury

Jonas

2021

J Hepato Biliary Pancreat

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Dear Editor, We congratulate Drs Ando and Okano and colleagues from the Japanese Society for Abdominal Emergency Medicine (JSAEM) on their excellent analysis and the exceptional outcome of patients treated for main pancreatic duct (MPD) injuries. 1 We concur that major pancreatic injuries still result in considerable morbidity, even when treated in well-resourced referral centers, and strongly endorse the notion proposed by the authors that experienced teams should be involved in the management of such injuries as in the JSAEM study. 1 We agree that it is judicious to involve a proficient pancreatic surgeon at an early stage as the technical intricacies both for resection and reconstruction of complex pancreatic injuries require special organ-specific surgical skills and expertise. 2 The authors do not detail the specifics, but current data support the use of initial damage-control laparotomy for complex combined pancreaticoduodenal injuries and delayed pancreatoduodenectomy (PD) once compromised patient physiology has been corrected. In the largest published series of PD for trauma, 19 patients in our unit had a PD, either at the initial operation (n = 13) or after damage control (n = 6). 2 The authors do not provide detailed information on the 41 patients who had endoscopic retrograde cholangiopancreatography (ERCP). In our report of 47 patients who underwent ERCP, 11 had an intact MPD with minor peripheral injuries which required no further intervention. A pancreatic fistula was demonstrated in 24 patients, a MPD stricture in 12 of whom 10 had a pseudocyst. Fifteen patients had a pancreatic duct sphincterotomy, seven had a pancreatic stent inserted, and six had an endoscopic pseudocyst drainage. 3 In a further study of 432 consecutive patients with pancreatic injuries, 27 who presented with delayed pancreatic complications underwent an ERCP. 4 The degree and extent of the MPD injury was assessed using the Cape Town pancreatographic grading system for pancreatic injuries, modified from the original Takishima classification. Fourteen patients with grade 2a, 3a, 3b, or 4c MPD injuries were successfully treated endoscopically with either pancreatic duct stenting or pseudocyst drainage while 13 patients with grade 4a or 4b duct injuries required surgical intervention after failed endoscopic management for complete MPD disconnection. 4

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Emergency pancreatoduodenectomy for complex injuries of the pancreas and duodenum

Abstract: A pancreatoduodenectomy is a life-saving procedure in a small cohort of stable patients with non-reconstructable pancreatic head injuries. Damage control before a pancreatoduodenectomy will salvage a proportion of the most severely injured patients who have multiple injuries.

Cited by 57 publications

References 23 publications

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft

Damage control laparotomy and delayed pancreatoduodenectomy for complex combined pancreatoduodenal and venous injuries

Pancreatic trauma with main pancreatic duct injury

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