A Case of Severe Traumatic Pancreatic Injury Treated with Pancreaticoduodectomy

Abstract

A 38-year-old male was admitted in emergency following a blunt abdominal trauma in a car accident. Since abdominal contrast CT showed bleeding from the posterior superior pancreaticoduodenal artery, pancreaticoduodectomy (PD) was performed on the pancreatic head injury after hemostasis was echieved, with interventional radiology (IVR). Postoperatively, the patient developed both abdominal compartment syndrome and deviation of a pancreatic duct tube, resulting in an external pancreatic fistula. Thereafter, the patient underwent pancreaticogastrostomy 188 days post-injury and was successfully discharged. PD is required in cases of severe pancreatic head injury. The mortality of PD in pancreatic injury exceeds 15% and the frequency of complications is high, therefore careful judgement is necessary for its application. Following successful surgery, it is also common for a large volume of fluid to accumulate at the injury site, thus the risk of developing acute coronary syndrome (ACS) is high. Two-stage PD should also be considered to prevent complications. Preventive procedures such as intraoperative open abdominal management should also be considered to reduce mortality.