Trauma Whipple at a community level 1 trauma center: a case report

Area of Science:

• Surgical Oncology
• Trauma Surgery
• Gastrointestinal Surgery

Background:

• The Whipple operation (pancreaticoduodenectomy) is a complex procedure typically for hepatopancreatobiliary malignancies.
• Traumatic injuries to the duodenum and pancreas requiring Whipple reconstruction are exceptionally rare.
• Such trauma cases present high risks of morbidity and mortality.

Observation:

• A 22-year-old female sustained severe abdominal injuries, including grade 3 duodenal, grade 4 pancreatic, and grade 4 renal injuries, from multiple gunshot wounds.
• The patient underwent a staged Whipple operation to address the extensive damage.
• The clinical course was complicated by a pancreaticojejunostomy leak, feeding tube leak, and mesenteric bleeding.

Findings:

• The patient required extensive surgical and interventional radiology management for postoperative complications.
• Despite the severity of injuries and complications, the patient demonstrated a significant recovery.
• A 46-day hospitalization preceded discharge to a rehabilitation facility.

Implications:

• This case highlights the feasibility of Whipple reconstruction in managing severe, complex abdominal trauma.
• It underscores the importance of multidisciplinary management, including surgical and interventional radiology, in optimizing outcomes for trauma patients.
• The successful, albeit challenging, recovery suggests potential for improved survival and quality of life in similar rare cases.