Abstract
A 39-year-old man sustained a blunt injury to the upper abdomen due to being kicked by a horse in a horse race, and was transferred to the emergency room in our hospital in a state of shock. The upper abdomen was tender and board-like. Abdominal CT scan showed type IIIb pancreatic head injury, type IIb duodenal injury, type IIIa liver injury, and rt. renal artery injury. Emergency laparotomy revealed complete disruption of the pancreas head and transaction of the second portion of the duodenum. We decided to employ pancreatoduodenectomy and damage control surgery. The pancreatic injury was managed by external drainage of pancreatic juice through a pancreatic tube and intra-abdominal drains. Immediately after the operation, TAE was performed for the liver injury and rt. renal artery injury. Forty-eight hours after the first operation, second-stage reconstruction was performed by the SSPPD IIA-1 method. The patient recovered quickly and was discharged without any major complications. A second-stage reconstruction following damage control surgery is a reasonable option for type IIIb pancreatic injury which can be a candidate for pancreatoduodenectomy.
