Post-traumatic duodenopancreatectomy: A real challenge for emergency physicians, anesthesiologists-intensivists, and...

Duodenopancreatic trauma, accounting for 3-5 % of abdominal injuries, poses a major challenge in trauma surgery. Their rarity and complexity demand rapid, expert management, often complicated by associated multivisceral injuries.

A 20-year-old male was admitted to the emergency department following a road traffic accident, presenting with severe cranial and abdominal impact trauma. Clinical examination revealed hemodynamic instability and abdominal distension with rigidity. Due to the patient's hemodynamic instability and the abdominal emergency, he was taken directly to the operating room without undergoing a CT scan. Urgent median laparotomy revealed a duodenal avulsion from D1 to D3 with partial detachment of the pancreatic head. The surgical intervention involved partial duodenal and pancreatic resection with complex reconstruction, including a jejunal patch and gastrojejunostomy. Postoperatively, the patient developed abdominal septic shock requiring intensive resuscitation measures. He was extubated on day 3, with continued monitoring in the ICU. Parenteral feeding was initiated on day 4, enteral feeding on day 17, and drains were removed on day 15. The patient was subsequently transferred to visceral surgery following favorable progression.

Duodenopancreatic traumas are rare surgical emergencies, representing 3-5 % of abdominal traumas, often complex due to associated injuries. Key challenges include difficult diagnosis due to initially subtle clinical signs, personalized surgical management (occasionally requiring post-traumatic pancreaticoduodenectomy, as in our case), frequent and potentially severe postoperative complications (e.g., fistulas, hemorrhages, abscesses), and significant long-term sequelae such as diabetes and exocrine pancreatic insufficiency. Long-term, multidisciplinary follow-up is essential to manage functional sequelae, including diabetes and steatorrhea.

Duodenopancreatic injuries have a high mortality rate (5-30 %). Rapid intervention, specialized surgical expertise, and rigorous follow-up are crucial for optimizing outcomes and quality of life for patients. This case highlights the importance of a personalized approach and close monitoring in managing these complex traumas.