Research article

Pancreas sparing duodenectomy as an emergency procedure

Piotr Paluszkiewicz^1* , Wojciech Dudek^2* , Kathryn Lowery^2* and Colin A Hart^2*

¹  Department of Surgery and Surgical Nursing, Medical University of Lublin, Lublin, Poland

²  Department of Surgery, Pilgrim Hospital, Boston, Lincolnshire, UK

author email corresponding author email* Contributed equally

World Journal of Emergency Surgery 2009, 4:19doi:10.1186/1749-7922-4-19

Published:	16 May 2009

Abstract

Background

The operative techniques to close extensive wounds to the duodenum are well described. However, postoperative morbidity is common and includes suture line leak and the formation of fistulae. The aim of this case series is to present pancreas sparing duodenectomy as a safe and viable alternative procedure in the emergency milieu.

Methods

Five patients underwent emergency pancreas sparing duodenal excisions. Re-implantation of the papilla of Vater or the papilla with a surrounding mucosal patch was performed in two patients. In one, the procedure was further supplemented with a duodenocholangiostomy, stapled pyloric exclusion and enterogastrostomy to defunction the pylorus. In another three patients, distal duodenal excisions were done.

Results

In four patients, an uneventful recovery was made. One patient died following a myocardial infarction. The surgery lasted meanly 160 minutes with average blood loss of approximately 500 milliliters. The mean hospital stay was 12 days. Enteral nutrition was introduced within the 20 hours after the surgery. Long term follow-up of all surviving patients confirmed a good outcome and normal nutritional status.

Conclusion

Based on the presented series of patients, we suggest that pancreas-sparing duodenectomy can be considered in selected patients with laceration of the duodenum deemed unsuitable for surgical reconstruction.