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The Role of Pancreatoduodenectomy in the Management of Complex Pancreatic Trauma

  • Conference paper
Pancreatoduodenectomy

Summary

Major injuries to the head of the pancreas are uncommon but may result in considerable morbidity and mortality because of the magnitude of associated trauma or underestimation of the extent of the injury with consequent inappropriate treatment. Prognosis is determined by the cause and extent of the pancreatic injury, the amount of blood loss, duration of shock, and rapidity of resuscitation and surgical intervention. Early mortality results from uncontrolled or massive bleeding from associated vascular and large organ injuries. Late mortality is a consequence of infection and multiple organ failure. Neglect of major duct injury may lead to life-threatening complications including pancreatitis, pseudocyst, fistula, sepsis, and secondary hemorrhage.

Pancreatoduodenectomy is reserved for maximal injuries to the head of pancreas and duodenum in which salvage or reconstruction is not feasible. The need for resection is usually obvious when there is massive destruction with gross devitalization or pancreatobiliary, duodenal, and ampullary disruption requiring debridement that results in a near-complete pancreatoduodenectomy. With less severe trauma to the head of the pancreas, in particular penetrating injuries, the decision whether to resect or to adopt a more conservative approach is more difficult and requires the assistance of an experienced pancreatic surgeon. The success of the treatment of complex injuries to the head of the pancreas depends largely on the initial correct assessment and appropriate treatment. The management of severe injuries to the head of the pancreas remains one of the most difficult challenges in abdominal trauma surgery.

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Author information

Authors and Affiliations

  1. Surgical Gastroenterology and Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, 7925, South Africa

    Jake Krige & Philippus C. Bornman

  2. Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, 7925, South Africa

    John Terblanche

Authors
  1. Jake Krige
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  2. Philippus C. Bornman
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  3. John Terblanche
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Editor information

Editors and Affiliations

  1. Tokyo Women’s Medical College, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162, Japan

    Fujio Hanyu M.D., Ph.D. (Professor Emeritus) (Professor Emeritus)

  2. Department of Surgery Institute of Gastroenterology, Tokyo Women’s Medical College, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162, Japan

    Ken Takasaki M.D., Ph.D. (Professor and Chairman) (Professor and Chairman)

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© 1997 Springer-Verlag Tokyo

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Krige, J., Bornman, P.C., Terblanche, J. (1997). The Role of Pancreatoduodenectomy in the Management of Complex Pancreatic Trauma. In: Hanyu, F., Takasaki, K. (eds) Pancreatoduodenectomy. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68541-8_6

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  • DOI: https://doi.org/10.1007/978-4-431-68541-8_6

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-68543-2

  • Online ISBN: 978-4-431-68541-8

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