Sewefy Alaa M
Minia University Hospital, Egypt
Title: Emergency pyloric preserving pancreaticoduodenectomy for isolated 5th degree blunt duodenal trauma with double loop (Roux en Y) technique
Biography
Biography: Sewefy Alaa M
Abstract
Pancreaticoduodenal injuries are often associated with complicated treatment strategies. Severe pancreaticoduodenal injuries involve a significant mortality rate ranging from 10 to 36%. In massive injury of proximal duodenum and or head of pancreas with destruction of the ampulla and proximal pancreatic duct, distal common bile duct may preclude reconstruction, in addition, because of duodenum and head of pancreas have the same blood supply it is impossible to make resection of one without ischemia of the other, in this situation pancreaticoduodenectomy is required. We present a case of male patient 35 years old presented to our ER (emergency room) by MVA (motor vehicle accident), the patient received ATLS (acute trauma life support) and was hemodynamacally stable, abdominal examination revealed tenderness all over the abdomen, abdominal US (utrasonography) was done and revealed mild free abdominal collection, plain X-ray image revealed free air under diaphragm, other emergency investigations were normal. The decision was abdominal exploration, after preparation of matched blood and revealed degloved 2nd part of the duodenum with no other organ injury. The decision was pancreaticoduenectomy and to decrease the blood loss and operative time we did PPPD (pyloric preserving pancreaticoduodenectomy) but with double jejunal loop to completely divert the biliopancreatic limb from food limb. The case passed with very good postoperative outcome only the patient developed incisional hernia.