A young patient presents with a massive injury to proximal duodenum, head of pancreas and distal common bile duct. The procedure of choice in this patient should be:
According to given situation, injury is Grade V injury,Pancreaticoduodenectomy to be done. Whipple's procedure/Pancreaticoduodenectomy * 1st - Pancreatico - jejunostomy* 2nd -Hepatico - jejunostomy* 3rd -Gastro - jejunostomy PANCREATIC TRAUMA- In adult: MC cause - Penetrating- In children: MC cause - Blunt trauma- Handlebar - bicycle- MC affected - body of pancreas Pancreatic organ injury scale Grade Hematoma Laceration I Minor contusion withoutduct injury Superficial laceration without duct injury II Major contusion withoutduct injury Major laceration without duct injury III - Distal transection or parenchymal injury with ductinjury IV - Proximal transection or parenchymal injury involvingAmpulla V - Massive disruption of pancreatic head Diagnosis- IOC for Dx - CECT- ERCP - Most reliable test to demonstrate pancreatic duct integrity Management- I - Observation- II - Debridement, drainage, possible repair- III - Distal resection, Roux-en-Y drainage- IV & V - Damage control surgery- Resection + Roux-en-Y drainage- Triple tube decompression- Pyloric exclusion- Duodenal diveicularization- Pancreatico Duodenectomy- MC complication seen after Pancreatic trauma - Pancreatic fistula / Persistent drain output
Roux-en-Y anastomosis
Pancreaticoduodenectomy
Lateral tube jejunostomy
Retrograde jejunostomy
Pancreas