Pancreas preserving total duodenectomy for complex duodenal injury.

CONTEXT To assess the feasibility and safety of a pancreas-preserving total duodenectomy in the management of severe duodenal injury caused by abdominal trauma. CASE REPORT Two patients with both extensive injury of the duodenum and diffuse peritonitis underwent pancreas preserving total duodenectomy at our tertiary care centre. These two young male patients (age 20 and 22 years) presented 2 days and 6 hours respectively following blunt abdominal trauma. The duodenum was almost completely separated from the pancreas. Ampulla was seen as a button on the pancreas. Following total duodenectomy, reconstruction was performed by suturing the jejunum to the head of the pancreas anteriorly and posteriorly away from the ampulla (invagination of the pancreas into the jejunum). There were no complications attributable to the procedure. Both patients are well on follow up. CONCLUSION A Pancreas-preserving total duodenectomy offers a safe alternative to the Whipple procedure in managing complex duodenal injury. This procedure avoids unnecessary resection of the adjacent pancreas and anastomosis to undilated hepatic and pancreatic ducts.

[1]  J. Scott,et al.  Management strategies in isolated pancreatic trauma. , 2009, Journal of hepato-biliary-pancreatic surgery.

[2]  D. Efron,et al.  Chapter 75 – Management of Pancreatic and Duodenal Injuries , 2009 .

[3]  Matthew J. Martin,et al.  Bioprosthetic repair of complex duodenal injury in a porcine model. , 2009, The Journal of trauma.

[4]  C. Schwab,et al.  Pancreatic Trauma: Demographics, Diagnosis, and Management , 2008, The American surgeon.

[5]  J. Gardner-Thorpe,et al.  Complications and follow‐up after pancreas‐preserving total duodenectomy for duodenal polyps , 2008, The British journal of surgery.

[6]  H. van Goor,et al.  Pancreas‐preserving total duodenectomy versus standard pancreatoduodenectomy for patients with familial adenomatous polyposis and polyps in the duodenum , 2008, The British journal of surgery.

[7]  K. Inaba,et al.  Pyloric Exclusion in the Treatment of Severe Duodenal Injuries: Results from the National Trauma Data Bank , 2008, The American surgeon.

[8]  C. Maurer,et al.  Prophylactic octreotide and delayed gastric emptying after pancreaticoduodenectomy: results of a prospective randomized double-blinded placebo-controlled trial. , 2008, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[9]  H. Friess,et al.  Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis? , 2008, American journal of surgery.

[10]  K. Jauch,et al.  The challenge of pancreatic anastomosis , 2008, Langenbeck's Archives of Surgery.

[11]  G. Velmahos,et al.  Safety of Repair for Severe Duodenal Injuries , 2009, World Journal of Surgery.

[12]  S. Fan,et al.  External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. , 2008, Annals of surgery.

[13]  A. Chaudhry,et al.  Injuries to the duodenum--prognosis correlates with body Injury Severity Score: a prospective study. , 2007, International journal of surgery.

[14]  A. Jawas,et al.  Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systematic review and meta-analysis. , 2007, Canadian journal of surgery. Journal canadien de chirurgie.

[15]  J. Kawamoto,et al.  Pancreas-preserving total duodenectomy without pancreato-enteric anastomosis. , 2007, Hepato-Gastroenterology.

[16]  M. Falconi,et al.  Isolated blunt duodenal trauma: delayed diagnosis and favorable outcome with "quadruple tube" decompression. , 2007, JOP : Journal of the pancreas.

[17]  E. Moore,et al.  Should pyloric exclusion for duodenal and pancreatico-duodenal injuries be abandoned? , 2007, Journal of Trauma.

[18]  J. Gaughan,et al.  A ten-year retrospective review: does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries? , 2007, The Journal of trauma.

[19]  A. Leppäniemi.  Management of pancreatic and duodenal injuries , 2007 .

[20]  Michael A. Choti,et al.  Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial , 2006, Journal of Gastrointestinal Surgery.

[21]  B. Kocer,et al.  Operative Approach in Traumatic Injuries of the Duodenum , 2006, Acta chirurgica Belgica.

[22]  Y. Kawarada,et al.  Blunt injury of duodenum with avulsion of papilla of vater , 1984, The Japanese journal of surgery.

[23]  S. D. de Castro,et al.  Incidence and management of pancreatic leakage after pancreatoduodenectomy , 2005, The British journal of surgery.

[24]  M. Imamura,et al.  New Pancreas-preserving Total Duodenectomy Technique , 2005, World Journal of Surgery.

[25]  M. Nance,et al.  Management of duodenal injuries in children. , 2004, Journal of pediatric surgery.

[26]  J. Izbicki,et al.  Pancreas-sparing duodenectomy in duodenal pathology: indications and results. , 2004, Hepato-gastroenterology.

[27]  Grishin Av,et al.  Injuries of pancreatoduodenal organs , 2003 .

[28]  P. Ivanov,et al.  [Injuries of pancreatoduodenal organs]. , 2003, Khirurgiia.

[29]  B. Warren,et al.  Duodenal injuries: surgical management adapted to circumstances. , 2002, Injury.

[30]  A. B. Molitvoslovov,et al.  [Duodenal injuries]. , 2000, Khirurgiia.

[31]  C. Timaran,et al.  Prognostic factors and management of civilian penetrating duodenal trauma. , 1999, The Journal of trauma.

[32]  W. Shoemaker,et al.  A unified approach to the surgical exposure of pancreatic and duodenal injuries. , 1997, American journal of surgery.

[33]  J. Church,et al.  Pancreas-sparing duodenectomy: indications, surgical technique, and results. , 1995, Surgery.

[34]  H. Cooke.  Avulsion of the ampulla of Vater following blunt trauma. , 1990, Australian and New Zealand Journal of Surgery.

[35]  E. J. White,et al.  Duodenal "diverticulization" for duodenal and pancreatic injury. , 1974, American journal of surgery.