2018 Volume 43 Issue 6 Pages 1116-1120
A man in his teens was admitted to our hospital after a Motor Vehicle Accident. Although initial abdominal CT showed slightly poor contrast enhancement in the head of pancreas, non operative management was performed because of no abdominal tenderness. Twelve hours after the accident, abdominal pain worsened, and fluid extravasation into the peritoneal and the retroperitoneal space around the pancreas head was obvious on repeat CT scan. We diagnosed a type Ⅲb pancreas injury by endoscopic retrograde pancreatography (ERP). Laparotomy was performed after we failed to place a stent in the main pancreatic duct. Saponification around the pancreas head, and a complete resection of the main pancreatic duct with injury of the pancreatic parenchyma at the level of the of the superior mesenteric vein (SMV) were found. After debridement around the injury, the proximal edge was simply closed and the distal side of the pancreas was anastomosed to the posterior wall of the stomach. Post-operative course was uneventful and the patient was discharged on POD 17. Our experience is that it is difficult to standardize surgical care for pancreatic trauma. Nevertheless, pancreasticogastrostomy is a simple and safe procedure for preserving the pancreas and the spleen.
