Combined pancreatoduodenal injuries

Area of Science:

• Trauma Surgery
• Surgical Gastroenterology
• Surgical Oncology

Background:

• Operative management of combined pancreatic and duodenal injuries remains controversial.
• Advocated methods include resection, duodenal diversion, and simple repair, with limited evidence due to small series.

Purpose of the Study:

• To evaluate the outcomes of various surgical interventions for combined pancreatic and duodenal injuries.
• To determine the most effective treatment modalities for these complex trauma cases.

Main Methods:

• Retrospective analysis of 68 patients with combined pancreatic and duodenal injuries over an 8-year period.
• Categorization of injuries into penetrating (55 patients) and blunt (13 patients).
• Review of surgical procedures including repair and drainage, duodenal diversion with pyloric exclusion, and pancreatoduodenectomy.

Main Results:

• Operative mortality rate was 26.4%, with only one death directly attributed to the pancreatoduodenal injury.
• Fifty-five patients had penetrating injuries, and 13 had blunt injuries.
• Extensive procedures were required for 50 patients, including duodenal diversion and pancreatoduodenectomy.

Conclusions:

• No single surgical procedure is uniformly applicable for combined pancreatic and duodenal injuries.
• Surgeons must be proficient in various techniques and individualize treatment based on injury severity.
• Tissue preservation should be prioritized whenever feasible.