Pancreaticoduodenectomy with left lateral hepatic segmentectomy : A rare procedure for the management of complex pancreaticoduodenal and liver injuries in blunt abdominal trauma.

Context : Pancreaticoduodenal complex injuries are uncommon after blunt abdominal trauma and are difficult to diagnose. Case Report : We report a case of 25 years old male who suffered massive Pancreaticoduodenal complex with liver injuries due to blunt abdominal trauma. At exploration we found that 2nd part of duodenum and head of pancreas were completely shattered and segment II & III of liver were lacerated. We performed Pylorus preserving Pancreaticoduodenectomy with segment II and III resection. Conclusion : Pancreaticoduodenal injuries should be suspected in every patient with trauma to upper abdomen. Exploration should be done at the earliest.

Evaluation on serum amylase level in the diagnosis of \r\n', u'pancreaticoduodenal injuries\r\n', u'

Background: Injuries to the pancreaticoduodenal complex present a significant challenge both in diagnosis and management. The retroperitoneal location of the pancreas means that it is not a common site of injury, but this also contributes to the difficulty in diagnosis. Objective: To evaluate changes of serum amylase level before the operation of pancreaticoduodenal injuries. Subjects and method: Prospective analysis of 156 patients with pancreaticoduodenal injuries from January 2000 to December 2006 was measured serum amylase level at admission. The factors analyzed in the study included age, gender, time elapsed from injury to admission, type of pancreaticoduodenal injuries according to The American Association for the Surgery of Trauma 1990. Results: The serum amylase level was found to be abnormal in all patients admitted more than 3 hours after trauma. Various comparisons between patients with elevated (78.2%) and nonelevated (26.3%) serum amylase levels showed the statistical significance solely of the time elapsed from injury to admission. The major factor that influenced the serum amylase level on admission appeared to be the time elapsed from injury to admission. Determination of the serum amylase level was no diagnosis within 3 hours or less after trauma, irrespective of the type of injury. Conclusions: To avoid failure in the detection of pancreaticoduodenal injuries, the authors advocate determination of serum amylase levels more than 3 hours after trauma.

Pyloric Exclusion in the Pancreaticoduodenal Injury / 한국간담췌외과학회지

BACKGROUND/AIMS: Pyloric exclusion has been recommended in patients with severe injury to the pancreas and duodenum. METHODS: A retrospective case review of 8 patients treated with pyloric exclusion following pancreaticoduodenal injury from March 1994 to May 2002 in Department of Surgery, the Catholic University of Korea, Daejeon St. Mary's Hospital. RESULTS: The age range of the patients was from 8 to 31 years. Most of the etiolgy (n=7) was the blunt abdominal trauma and one case due to the iatrogenic injury from the therapeutic endoscopic retrograde cholangiopancretography. The time interval between the injury and the operation varied from 3 to 48 hours. The most common postoperative complication was wound infection (n=8). We found the other complications such as intraabdominal abscess (n=3), pneumonia (n=3), but the complications were treated successfully with conservative measures. There was no mortality cases in these patients. The duration of admission was delayed in the cases of concomitant injury (64 vs 46 days). All patients above 16 years old (n=7) were supported with parenteral nutritional fluid via central intravenous route (mean 32 days). We could not find the spontaneous opening of the pyloric closure at least 4 patients in postoperative 3 months but there was no major complication according to the sustained gastrojejunostomy. CONCLUSION: Pyloric exclusion appears to offer a satisfactory option for the treatment of the severe pancreaticoduodenal injury with minor complication. Do you have any comments about the spontaneous opening of the pyloric closure?