Emergency pancreaticoduodenectomy for complex pancreaticoduodenal damage with multiple organ injuries following blunt abdominal trauma: A case report and literature review

Introduction: Pancreaticoduodenectomy is a complex surgical procedure with significant potential for complications such as pancreatic fistula, bile leakage, intra-abdominal abscesses, and hemorrhage. Emergency pancreaticoduodenectomy (EPD) performed for traumatic injuries carries even greater risks due to the patient's severely unstable condition upon admission. While the literature recommends that EPD be reserved for hemodynamically stable trauma patients, there are scenarios where it may be the last resort to save the patient's life.

Case presentation: A 49-year-old male presented in the emergency department after a collision with a truck. He sustained extensive pancreaticoduodenal deconstruction combined with IVC, liver, right kidney, and right adrenal injuries following blunt abdominal trauma. Despite the patient's hemodynamic instability, the surgical team proceeded with EPD combined with IVC repair, right nephrectomy, adrenalectomy, cholecystectomy, and liver hemostasis. Postoperative complications included biliary leakage and intraabdominal abscess, all of which were successfully conservatively managed.

Clinical discussion: Upon entering the abdomen, the priority was rapid identification and control of the significant bleeding, particularly from the injured IVC. While additional procedures like nephrectomy and adrenalectomy were required, continued bleeding from the crushed pancreatic head left EPD as the only viable option to save the patient.

Conclusion: EPD can be a lifesaving procedure for a small portion of trauma patients with non-reconstructable pancreaticoduodenal injury, even in the setting of hemodynamic instability. However, it should only be performed at high-volume centers and by experienced hepato-pancreato-biliary surgeons.