2021 Volume 54 Issue 7 Pages 456-463
A 67-year-old woman was transferred to our hospital because of severe abdominal pain. An abdominal CT scan showed free air and fluid collection in the peritoneal space. Under a diagnosis of panperitonitis due to duodenal perforation, an emergency operation was performed. On laparotomy, multiple duodenal perforations were observed. Furthermore, extensive mucosal necrosis was present from the duodenal bulb to the second part beyond the papilla of Vater. Emergency pancreatoduodenectomy was performed, but digestive tract reconstruction was abandoned as damage control because the patient entered a shock state. After external fistulation tubes were placed in the bile duct, pancreatic duct and stomach, the abdominal wall was closed. Two-stage surgery for digestive tract reconstruction was performed 72 hours after the first surgery when the systemic condition had stabilized. Although complications such as bleeding, thyroid crisis, and intractable arrhythmia occurred postoperatively, the patient recovered and was moved to a rehabilitation ward 65 days after the first surgery. Emergency pancreatoduodenectomy due to duodenal injury or bleeding is relatively rare, and there has been no report of pancreatoduodenectomy for panperitonitis due to duodenal necrosis. Thus, we report this case as a rare use of this treatment.
