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Alia VS, Alvarado EW, Diaz EM, Albo D, Galindo R. From the borders edge to the brink of death: A case of a traumatic pancreatic injury and Whipple procedure in the Rio Grande Valley. Trauma Case Rep 2023; 48:100940. [PMID: 37772085 PMCID: PMC10522855 DOI: 10.1016/j.tcr.2023.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 09/30/2023] Open
Abstract
The traumatic pancreatoduodenectomy, also known as the traumatic Whipple, is a specialized surgical procedure often reserved for extreme cases in which an individual suffers traumatic injuries to the pancreas, duodenum, or periampullary structures. Traditionally, a Whipple procedure is a complex surgery involving the removal of the head of the pancreas, duodenum, and a portion of both the bile duct and stomach, for the management of pancreatic head cancer. In underserved communities where limited access to healthcare is coupled with a higher incidence of trauma, the lack of specialized and supportive care for patients suffering from pancreatic injuries may lead to an increased morbidity and mortality rate. This case report aims to provide a detailed analysis of a patient who underwent a traumatic pancreatoduodenectomy in a medically underserved region in South Texas, while discussing the rarity of the procedure, its incidence and mortality rates, as well as the subsequent outcomes faced by individuals in this patient population.
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Affiliation(s)
- Valentine S. Alia
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, United States of America
| | - Ed W. Alvarado
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, United States of America
| | - Edward M. Diaz
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, United States of America
- Department of Surgery, Valley Baptist Medical Center, Harlingen, TX, United States of America
| | - Daniel Albo
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, United States of America
- Department of Surgery, Valley Baptist Medical Center, Harlingen, TX, United States of America
| | - Roger Galindo
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, United States of America
- Department of Surgery, Valley Baptist Medical Center, Harlingen, TX, United States of America
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Gao J, Li H, Yang J, Wang J, Ai T, He P, Wei G, Xiang Z, Zhao S. Surgical management of duodenal injury: experience from 92 cases. Eur J Trauma Emerg Surg 2023; 49:1367-1374. [PMID: 36763155 DOI: 10.1007/s00068-023-02238-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Duodenal injury increases with traffic accidents, and delayed diagnosis or inappropriate operation increase mortality and complications. This study aimed to explore early recognition and timely surgical intervention. METHODS All patients with duodenal injuries treated operatively during the past 10 years were reviewed, and the data were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. RESULTS A total of 92 patients with duodenal injuries accounted for 7.3% of 1258 patients with abdominal injury. Of the 92 patients, 71 (77.17%) experienced blunt trauma, with traffic accidents accounting for 59.2% (42/71). In 35 patients, a preoperative diagnosis was obtained by reviewing abdominal signs, peritoneocentesis, and imaging. The remaining 57 patients underwent urgent laparotomy, through which a definitive diagnosis of duodenal injury was confirmed during the operation. In all 92 patients, the surgical procedures involved simple sutures; pedicled jejunal piece coverings; and various anastomoses following resection of the injured duodenal portion, including the Whipple procedure and damage-control surgery principles. The overall mortality rate was 12.0% (11/92) with deaths mainly occurring due to associated injuries. When excluding 2 cases of intraoperative death, there were 47 cases in the double-tube gastrostomy group and 43 cases in the traditional triple-tube group, with mortality rates of 10.64% and 9.30% in the two groups, respectively (χ2 = 0.045, P > 0.05). Postoperative complications occurred in 15 patients (18.5%). There was a high incidence of duodenal (or pancreatic/biliary) leakage. CONCLUSION Early diagnosis and operation of duodenal injury are crucial to reducing complications and mortality. Surgical methods should be based on injury grade, associated injuries, and vital signs. Double-tube gastrostomy can reduce complications such as intestinal obstruction.
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Affiliation(s)
- Jinmou Gao
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China.
| | - Hui Li
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Jun Yang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Jianbai Wang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Tao Ai
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Ping He
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Gongbin Wei
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Zhen Xiang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Shanhong Zhao
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
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Chui JN, Kotecha K, Gall TMH, Mittal A, Samra JS. Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit. World J Gastrointest Surg 2023; 15:834-846. [PMID: 37342855 PMCID: PMC10277947 DOI: 10.4240/wjgs.v15.i5.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/22/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The management of high-grade pancreatic trauma is controversial.
AIM To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries.
METHODS A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma (AAST) Grade III or greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified.
RESULTS Over a twenty-year period, 14 patients underwent pancreatic resection for high-grade injuries. Seven patients sustained AAST Grade III injuries and 7 were classified as Grades IV or V. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy (PD). Overall, there was a predominance of blunt aetiologies (11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases (7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies.
CONCLUSION We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.
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Affiliation(s)
- Juanita Noeline Chui
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, NSW, Australia
| | - Krishna Kotecha
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
| | - Tamara MH Gall
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, NSW, Australia
- Department of Surgery, University of Notre Dame, Sydney 2006, NSW, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, NSW, Australia
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Williams EM, Croft CA, Taylor JE. Inferior Vena Cava Ligation and Pancreaticoduodenectomy in a Patient With Penetrating Abdominal Trauma. Am Surg 2022; 88:1554-1556. [PMID: 35392665 DOI: 10.1177/00031348221083941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Injury to the inferior vena cava (IVC) is often fatal. Pancreaticoduodenectomy for trauma is also rare. This case describes a patient who underwent both procedures. CASE PRESENTATION A 30-year-old male presented status post gunshot to the abdomen. He was taken to the operating room and found to have 6 cm defect in the IVC, which was ligated. Despite resuscitation, the patient required emergent return to the OR where bleeding from the pancreaticoduodenal artery was noted in addition to injuries in the stomach, duodenum, and pancreas. He subsequently underwent a pancreaticoduodenectomy. He was discharged after a month-long hospital stay. CONCLUSIONS This case demonstrates that IVC ligation is a form of damage of control surgery. Pancreaticoduodenectomy is rarely performed during the index operation for trauma patients. Patient with injuries to the pancreaticoduodenal complex can be life-threatening if not rapidly controlled. This patient is a rare example of someone who survived two morbid trauma surgery interventions.
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Affiliation(s)
- Eric M Williams
- Department of Surgery, 3463University of Florida, Gainesville, FL, USA
| | - Chasen A Croft
- Department of Surgery, 3463University of Florida, Gainesville, FL, USA
| | - Jessica E Taylor
- Department of Surgery, 3463University of Florida, Gainesville, FL, USA
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Kang SM, Kim IK, Lee JG. Management of Traumatic Duodenal Injuries: A Report from a Single-Center. JOURNAL OF ACUTE CARE SURGERY 2022. [DOI: 10.17479/jacs.2022.12.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Traumatic duodenal injury is uncommon and due to its difficult diagnosis and accessibility there is an increased risk of mortality and morbidity.Methods: Electronic medical records of a single center were reviewed retrospectively from March 2008 to December 2020 and a total of 7 cases of traumatic duodenal injury were managed by surgical exploration. The site of duodenal perforation, injury mechanisms, operation method, and postoperative outcomes were assessed.Results: The mean age was 55.72 years (range, 34-78), and there were 5 men in the study. The most common mechanism was in-car traffic accident (4 cases), and 1 case each of pedestrian accident, accident during work, and self-injured stab wound. The most common site of injury was between the 3rd and 4th portion (3 cases), followed by the bulb and 1st portion (2 cases), and 2nd portion (2 cases). Segmental resection of the duodenum and primary anastomosis was performed in the 3rd and 4th portion perforation. In cases of 1st and 2nd portion, injury was managed by primary repair or pylorus preserving pancreaticoduodenectomy. Complications developed in 4 patients, and the most common complication was a problem with the wound; wound seromas developed in 4 cases, entero-cutaneous fistula in 1, and biliary complications in 2 cases. Two patients suffered from intraperitoneal abscess or fluid collection managed by percutaneous drainage. The mean duration of hospital stay was 34 days, and postoperative mortality did not develop.Conclusion: Favorable clinical outcomes were observed in patients with traumatic duodenal injury managed by various surgical approaches.
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Chen JB, Luo SC, Chen CC, Wu CC, Yen Y, Chang CH, Chen YA, P'eng FK. Colo-pancreaticoduodenectomy for locally advanced colon carcinoma-feasibility in patients presenting with acute abdomen. World J Emerg Surg 2021; 16:7. [PMID: 33639983 PMCID: PMC7913271 DOI: 10.1186/s13017-021-00351-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/11/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND En bloc right hemicolectomy plus pancreaticoduodenectomy (PD) is administered for locally advanced colon carcinoma that invades the duodenum and/or pancreatic head. This procedure may also be called colo-pancreaticoduodenectomy (cPD). Patients with such carcinomas may present with acute abdomen. Emergency PD often leads to high postoperative morbidity and mortality. Here, we aimed to evaluate the feasibility and outcomes of emergency cPD for patients with advanced colon carcinoma manifesting as acute abdomen. METHODS We retrospectively reviewed 4898 patients with colorectal cancer who underwent curative colectomy during the period from 1994 to 2018. Among them, 30 had locally advanced right colon cancer and had received cPD. Among them, surgery was performed in 11 patients in emergency conditions (bowel obstruction: 6, perforation: 3, tumor bleeding: 2). Selection criteria for emergency cPD were the following: (1) age ≤ 60 years, (2) body mass index < 35 kg/m2, (3) no poorly controlled comorbidities, and (4) perforation time ≤ 6 h. Three patients did not meet the above criteria and received non-emergency cPD after a life-saving diverting ileostomy, followed by cPD performed 3 months later. We analyzed these patients in terms of their clinicopathological characteristics, the early and long-term postoperative outcomes, and compared findings between emergency cPD group (e-group, n = 11) and non-emergency cPD group (non-e-group, n = 19). After cPD, staged pancreaticojejunostomy was performed in all e-group patients, and on 15 of 19 patients in the non-e-group. RESULTS The non-e-group was older and had a higher incidence of associated comorbidities, while other clinicopathological characteristics were similar between the two groups. None of the patients in the two groups succumbed from cPD. The postoperative complication rate was 63.6% in the e-group and 42.1% in the non-e-group (p = 0.449). The 5-year overall survival rate were 15.9% in the e-group and 52.6% in the non-e-group (p = 0.192). CONCLUSIONS Emergency cPD is feasible in highly selected patients if performed by experienced surgeons. The early and long-term positive outcomes of emergency cPD are similar to those after non-emergency cPD in patients with acute abdominal conditions.
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Affiliation(s)
- Joe-Bin Chen
- Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Environmental Engineering, Dayeh University, Changhwa, Taiwan
| | - Shao-Ciao Luo
- Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chou-Chen Chen
- Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Environmental Engineering, Dayeh University, Changhwa, Taiwan
| | - Cheng-Chung Wu
- Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Cancer Translational Research Center, Taipei Medical University, Taipei, Taiwan.
- Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan.
| | - Yun Yen
- Cancer Translational Research Center, Taipei Medical University, Taipei, Taiwan
| | - Chuan-Hsun Chang
- Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yun-An Chen
- Department of Pathology, Taichung Veterans General Hospital, Taiwan Boulevard Sec. 4, No. 1650, Taichung, 40705, Taiwan
| | - Fang-Ku P'eng
- Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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