Pancreaticoduodenectomy For Complex Pancreaticoduodenal Trauma: A Case Series

Abstract

Introduction: Pancreaticoduodenectomy (Whipple’s) procedure is indicated for complex pancreatic injuries, with immediate reconstruction for stable patients and delayed reconstruction for unstable patients. This study aimed to review the authors’ experience with trauma related Whipple’s procedure at the East Avenue Medical Center (EAMC). Methods: This study reviews cases where Whipple’s procedure was performed from 2011 to 2015 at EAMC. Data collected included age, gender, mechanism of injury, presentation, patient Injury Severity Score (ISS), time interval between injury to presentation, associated injury, surgical procedure, time and type of surgical reconstruction after resection complications and 30-day mortality. Results: During the 5-year period, 4 patients underwent Whipple’s. All patients were male, mean age of 33.25 (range 29-48). Penetrating gunshot trauma was the predominant mechanism of injury (75% of cases) whereas peritonitis was the most common presentation (75% of cases). Mean ISS score is 29.5 (range 25-37). Among them, 2 underwent initial resection with delayed reconstruction and the other 2 underwent immediate reconstruction. Pancreaticojejunostomy was done for all pancreatic reconstruction. Cholecystojejunostomy (75%) and Choledochojejunostomy (25%) for biliary enteric conduit. Complications included pancreatic leak (50%), sepsis (25%) and pneumonia (25%). Overall, 30-day mortality rate was 25%. Pancreatic leak was noted on all patients without stent placed on the pancreatic anastomosis. Conclusion: Use of stents in pancreatic anastomosis in Whipple’s for trauma may lessen the pancreatic leak rates, further studies are needed to prove this. Cholecystojejunostomy can be an option for biliary enteric continuity, but further studies are needed to identify long term patency rates. Key words: Pancreaticoduodenectomy, pancreatic leak, pancreatic injury