Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery

Area of Science:

• Gastroenterology
• Surgical Oncology
• Hepatobiliary Surgery

Background:

• Pancreatoduodenectomy (PD) safety has improved significantly with reduced mortality and morbidity in experienced centers.
• Emergency PD is rare, typically for trauma, bleeding, or perforation.
• This study focuses on nontrauma emergency PD for pancreaticoduodenal bleeding.

Purpose of the Study:

• To present a single-center experience with emergency pancreatoduodenectomy for non-trauma related pancreaticoduodenal bleeding.
• To evaluate the outcomes of this rare but critical surgical procedure.

Main Methods:

• A retrospective review of patients undergoing emergency PD between January 2007 and December 2015.
• Five patients (3.7%) underwent one-stage emergency PD for uncontrollable non-trauma pancreaticoduodenal bleeding.

Main Results:

• All 5 patients underwent a backwards Whipple procedure.
• The overall morbidity rate was 60%, with a mortality rate of 20% (1 patient).
• Four patients recovered and were discharged with a median postoperative stay of 17 days.

Conclusions:

• Emergency pancreatoduodenectomy is a definitive, life-saving intervention for intractable pancreaticoduodenal bleeding.
• It is considered when less invasive treatments like transcatheter arterial embolization or endoscopy are ineffective or contraindicated.
• The procedure should be performed by experienced pancreatic surgeons, especially in cases of neoplastic disease.