Emergency pancreatoduodenectomy for non-traumatic conditions: a case series analysis

Emergency pancreaticoduodenectomy (EPD) is an uncommon abdominal surgical procedure primarily performed in patients with severe acute abdominal trauma. Performing EPD requires strict surgical criteria, advanced technical expertise, and comprehensive postoperative management. Limited research exists regarding the indications for non-traumatic EPD. Thus, the objective of this study was to synthesize and analyze recent cases of non-traumatic EPD, thereby enhancing the comprehension of this urgent surgical measure.

A retrospective analysis was conducted on patients who underwent non-traumatic EPD at the 900th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2013 to September 2023. The study assessed preoperative etiologies, intraoperative findings, postoperative complications, and prognosis. Additionally, a literature review was performed.

Nine patients underwent non-traumatic EPD. All patients demonstrated clear indications for emergency surgery: three cases of gastrointestinal hemorrhage secondary to ulcerative lesions, three cases of perforation (n = 2) and bleeding (n = 1) following invasive endoscopic procedures for neoplastic lesions, two cases of tumor rupture-related hemorrhage, and one case of postoperative anastomotic bleeding. All patients completed the surgical procedure. The operative duration ranged from 185.0 to 480.0 min, with a mean of 299.9 ± 83.3 min, and intraoperative blood loss ranged from 100.0 to 6,000.0 ml, with a mean of 1,477.8 ± 1,944.7 ml. Postoperative pathology revealed that 3 cases involved benign ulcerative lesions of the digestive tract and 6 cases involved neoplastic lesions in the pancreaticoduodenal region. One patient died 6 days postoperatively due to multiple organ failure, another died 42 days postoperatively due to tumor progression, and the remaining 7 patients recovered and were discharged, with a postoperative hospital stay of 17-45 days, mean 36.3 ± 10.5 days. Postoperative complications occurred in six patients (85.7%), including pancreatic fistula, biliary fistula, and abdominal infection, all of which resolved with conservative management.

In cases of non-traumatic emergencies in the pancreaticoduodenal region where conservative or minimally invasive treatments fail to control the acute progression, EPD serves as a critical surgical intervention that may save lives and yield favorable outcomes.