Abstract
We report a case of pancreatoduodenal injury successfully treated with second-stage pancreatojejunostomy. A 60-year-old man sustained a blunt injury to the upper abdomen due to falling from a height of 4 m. Emergency laparotomy revealed complete disruption of the head of the pancreas and transection of the first portion of the duodenum. The distal end of the transected portion of the duodenum was closed, and distal gastrectomy with Billroth II reconstruction was performed. Pancreatic injury was managed by external drainage of pancreatic juice through the pancreatic tube and intra-abdominal drains. Postoperative percutaneous biliary drainage was required because of delayed common bile duct obstruction. Three months after the injury, the patient underwent delayed reconstruction by the modified Child's method and recovered uneventfully. In the case of proximal pancreatic injuries with disruption of the main pancreatic duct, procedures to preserve the distal pancreas are required. However, these procedures may be hazardous in unstable patients. Hence, a delayed second-stage reconstruction following an abbreviated emergency laparotomy is a reasonable option.
