[Complex duodenopancreatic injuries]

Injuries of the duodenopancreatic region are rare and difficult to diagnose and treat. The related high mortality is mainly due to the presence of associated lesions. Complex traumas (AAST grade IV and V lesions) require difficult surgical treatment with high postoperative morbidity and mortality rates. In a review of 200 pancreaticoduodenectomies performed for pancreatic head traumas the postoperative mortality was 31%. The authors present 6 cases of complex duodenopancreatic traumas, treated from 1995 to 1999. The aetiology was blunt trauma in 5 cases (83%) and a shotgun wound in 1 case (17%). In 3 cases, with a grade V lesion of the pancreatic head, a pancreaticoduodenectomy was performed. A case of a grade IV lesion of the tail of the pancreas was treated with distal splenopancreatectomy. Two cases of grade IV lesions of the third part of the duodenum were submitted to duodenal resection with direct anastomosis. One postoperative death was observed in a patient treated with duodenal resection. The overall mortality was 16%. A pancreatic fistula, which healed spontaneously, was observed in a case of pancreaticoduodenectomy.