“…In this cohort of patients reconstruction is frequently technically difficult as the ducts are non-dilated and the surrounding organs damaged or oedematous which necessitates modification of conventional biliary and pancreatic anastomoses. 1,2,4,11 Unlike previous publications, a novel feature in this study was the ability to do a PPPD in a substantial proportion of injured patients. Importantly, in those patients who, in addition to maximal injuries to the pancreas, also had severe injuries to adjacent vascular, biliary, enteric, colonic or solid organs and had persistent shock, an initial damage control operation was followed by a delayed pancreatoduodenectomy and reconstruction when the patient was stable.…”