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Li X, Hong W, Zou Z, Du J, Su R, Wang L, Xiao C, Wang M. Emergency pancreatoduodenectomy for non-traumatic conditions: a case series analysis. BMC Gastroenterol 2025; 25:301. [PMID: 40287626 PMCID: PMC12034181 DOI: 10.1186/s12876-025-03868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 04/08/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND Emergency pancreaticoduodenectomy (EPD) is an uncommon abdominal surgical procedure primarily performed in patients with severe acute abdominal trauma. Performing EPD requires strict surgical criteria, advanced technical expertise, and comprehensive postoperative management. Limited research exists regarding the indications for non-traumatic EPD. Thus, the objective of this study was to synthesize and analyze recent cases of non-traumatic EPD, thereby enhancing the comprehension of this urgent surgical measure. METHODS A retrospective analysis was conducted on patients who underwent non-traumatic EPD at the 900th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2013 to September 2023. The study assessed preoperative etiologies, intraoperative findings, postoperative complications, and prognosis. Additionally, a literature review was performed. RESULTS Nine patients underwent non-traumatic EPD. All patients demonstrated clear indications for emergency surgery: three cases of gastrointestinal hemorrhage secondary to ulcerative lesions, three cases of perforation (n = 2) and bleeding (n = 1) following invasive endoscopic procedures for neoplastic lesions, two cases of tumor rupture-related hemorrhage, and one case of postoperative anastomotic bleeding. All patients completed the surgical procedure. The operative duration ranged from 185.0 to 480.0 min, with a mean of 299.9 ± 83.3 min, and intraoperative blood loss ranged from 100.0 to 6,000.0 ml, with a mean of 1,477.8 ± 1,944.7 ml. Postoperative pathology revealed that 3 cases involved benign ulcerative lesions of the digestive tract and 6 cases involved neoplastic lesions in the pancreaticoduodenal region. One patient died 6 days postoperatively due to multiple organ failure, another died 42 days postoperatively due to tumor progression, and the remaining 7 patients recovered and were discharged, with a postoperative hospital stay of 17-45 days, mean 36.3 ± 10.5 days. Postoperative complications occurred in six patients (85.7%), including pancreatic fistula, biliary fistula, and abdominal infection, all of which resolved with conservative management. CONCLUSION In cases of non-traumatic emergencies in the pancreaticoduodenal region where conservative or minimally invasive treatments fail to control the acute progression, EPD serves as a critical surgical intervention that may save lives and yield favorable outcomes.
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Affiliation(s)
- Xinxiong Li
- Department of General Surgery, Dongfang Hospital of Xiamen University/900 th Hospital of the United Logistics Force, 156 Xierhuan Northern Road, Fuzhou, Fujian, 350025, People's Republic of China
- Department of Thyroid Hernia Surgery, Fujian Provincial Hospital, Fuzhou University, Fuzhou, Fujian, China
| | - Weixuan Hong
- Department of General Surgery, Dongfang Hospital of Xiamen University/900 th Hospital of the United Logistics Force, 156 Xierhuan Northern Road, Fuzhou, Fujian, 350025, People's Republic of China
| | - Zhongdong Zou
- Department of General Surgery, Dongfang Hospital of Xiamen University/900 th Hospital of the United Logistics Force, 156 Xierhuan Northern Road, Fuzhou, Fujian, 350025, People's Republic of China
| | - Junhao Du
- Department of General Surgery, Dongfang Hospital of Xiamen University/900 th Hospital of the United Logistics Force, 156 Xierhuan Northern Road, Fuzhou, Fujian, 350025, People's Republic of China
| | - Ruohan Su
- Department of General Surgery, Dongfang Hospital of Xiamen University/900 th Hospital of the United Logistics Force, 156 Xierhuan Northern Road, Fuzhou, Fujian, 350025, People's Republic of China
| | - Lie Wang
- Department of General Surgery, Dongfang Hospital of Xiamen University/900 th Hospital of the United Logistics Force, 156 Xierhuan Northern Road, Fuzhou, Fujian, 350025, People's Republic of China
| | - Chunhong Xiao
- Department of General Surgery, Dongfang Hospital of Xiamen University/900 th Hospital of the United Logistics Force, 156 Xierhuan Northern Road, Fuzhou, Fujian, 350025, People's Republic of China.
| | - Meiping Wang
- Department of General Surgery, Dongfang Hospital of Xiamen University/900 th Hospital of the United Logistics Force, 156 Xierhuan Northern Road, Fuzhou, Fujian, 350025, People's Republic of China.
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Tanemura M, Cho A, Niwa Y, Ishita T, Mouri T, Sugishita T, Higuchi R, Ota M, Yoshida K, Katagiri S. Successful embolization with subsequent pancreaticoduodenectomy for intraductal papillary mucinous neoplasm hemorrhage: a case report and review of literature. Clin J Gastroenterol 2024; 17:1118-1124. [PMID: 39256306 DOI: 10.1007/s12328-024-02035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024]
Abstract
Although various complications associated with intraductal papillary mucinous neoplasms have been reported, including acute pancreatitis, duct perforation, and fistula formation, spontaneous bleeding, especially life-threatening bleeding, is infrequent. In this case, emergency pancreatic resection might be one of the therapeutic options, which is associated with poor postoperative outcomes. An 87-year-old woman presented to our hospital with severe anemia (hemoglobin, 4.5 g/dl). Contrast-enhanced computed tomography revealed a large cystic lesion in the pancreatic head measuring 15 cm, with some solid components and an adjacent hematoma, suggestive of intra-cystic hemorrhage of the intraductal papillary mucinous neoplasm. The patient was hemodynamically unstable and had hypotension. After transcatheter arterial embolization, the patient became hemodynamically stable. Subsequently, an elective pylorus-preserving pancreaticoduodenectomy was successfully performed. Preoperative embolization was effective for subsequent elective pancreaticoduodenectomy in patients with severe intraductal papillary mucinous neoplasm bleeding.
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Affiliation(s)
- Moe Tanemura
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Akihiro Cho
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan.
| | - Yukiko Niwa
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Takeshi Ishita
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Toshihiko Mouri
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Toshiya Sugishita
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Ryota Higuchi
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Masaho Ota
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Keita Yoshida
- Division of Pathology, Yachiyo Medical Center, Tokyo Women's Medical University, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Satoshi Katagiri
- Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba, 276-8524, Japan
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Cho A, Katagiri S, Ota M, Onizawa S, Higuchi R, Sugishita T, Niwa Y, Ishita T, Mouri T, Kato A, Iwata M. No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature. World J Gastrointest Surg 2024; 16:1910-1917. [PMID: 38983346 PMCID: PMC11230025 DOI: 10.4240/wjgs.v16.i6.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/08/2024] [Accepted: 04/30/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Emergency pancreaticoduodenectomy (EPD) is a rare event for complex periampullary etiology. Increased intraoperative blood loss is correlated with poor postoperative outcomes. CASE SUMMARY Two patients underwent EPD using a no-touch isolation technique, in which all arteries supplying the pancreatic head region were ligated and divided before manipulation of the pancreatic head and duodenum. The operative times were 220 and 239 min, and the blood loss was 70 and 270 g, respectively. The patients were discharged on the 14th and 10th postoperative day, respectively. Thirty-two patients underwent EPD for the treatment of neoplastic bleeding. The mean operative time was 361.6 min, and the mean blood loss was 747.3 g. The complication rate was 37.5%. The in-hospital mortality rate was 9.38%. CONCLUSION The no-touch isolation technique is feasible, safe, and effective for reducing intraoperative blood loss in EPD.
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Affiliation(s)
- Akihiro Cho
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Satoshi Katagiri
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Masao Ota
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Shunsuke Onizawa
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Ryota Higuchi
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Toshiya Sugishita
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Yukiko Niwa
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Takeshi Ishita
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Toshihiko Mouri
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Akita Kato
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
| | - Moe Iwata
- Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
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Miyama A, Chikaishi Y, Kobayashi D, Matsuo K, Ochi T, Nakamura K, Endo T, Kikuchi K, Katsuno H, Nishijima A, Morise Z. A case of non-ampullary duodenal adenosquamous carcinoma with successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage. Surg Case Rep 2023; 9:161. [PMID: 37698671 PMCID: PMC10497460 DOI: 10.1186/s40792-023-01749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Although most duodenal carcinomas are pathological adenocarcinomas, a small number of cases have been reported of adenosquamous carcinoma, characterized by variable combinations of two malignant components: adenocarcinoma and squamous cell carcinoma. However, owing to the small number of cases of non-ampullary duodenal adenosquamous carcinoma, there have been no reported cases of emergency pancreaticoduodenectomy for gastrointestinal hemorrhage due to non-ampullary duodenal adenosquamous carcinoma. CASE PRESENTATION A 66-year-old Japanese male presented to the referring hospital with a chief complaint of abdominal pain, diarrhea, and dark urine that had persisted for 1 month. The patient was referred to our hospital because of liver dysfunction on a blood examination. Laboratory results of the blood on the day of admission showed that total and direct bilirubin levels (12.0 mg/dl and 9.6 mg/dl) were markedly increased. An endoscopic retrograde biliary drainage tube was inserted for the treatment of obstructive jaundice, and imaging studies were continuously performed. Contrast-enhanced computed tomography and endoscopy revealed an ill-defined lesion involving the second portion of the duodenum, predominantly along the medial wall, and measuring 60 mm in diameter. No metastases were observed by positron emission tomography. Pancreaticoduodenectomy was planned based on the pathological findings of poorly differentiated adenocarcinoma. However, 2 days before the scheduled surgery, the patient experienced hemorrhagic shock with melena. Owing to poor hemostasis after endoscopic treatment and poor control of hemodynamic circulation despite blood transfusion, radiological embolization and hemostasis were attempted but were incomplete. An emergency pancreaticoduodenectomy was performed after embolizing the route from the gastroduodenal artery and pseudoaneurysm area to reduce bleeding. The operation was completed using an anterior approach without Kocherization or tunneling due to the huge tumor. The operation time was 4 h and 32 min, and blood loss was 595 mL The pathological diagnosis was adenosquamous carcinoma. The postoperative course was uneventful with 17 day hospital stay and the patient is currently well, with no signs of recurrence 9 months after surgery. CONCLUSIONS This report presents an extremely rare case of successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage caused by non-ampullary duodenal adenosquamous carcinoma.
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Affiliation(s)
- Arimasa Miyama
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Yuko Chikaishi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Daigo Kobayashi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Takayuki Ochi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Aki Nishijima
- Department of Diagnostic Pathology, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, 444-0827, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan.
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Fickenscher M, Vorontsov O, Müller T, Radeleff B, Graeb C. Pancreaticobiliary Diseases with Severe Complications as a Rare Indication for Emergency Pancreaticoduodenectomy: A Single-Center Experience and Review of the Literature. J Clin Med 2023; 12:5760. [PMID: 37685827 PMCID: PMC10488344 DOI: 10.3390/jcm12175760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023] Open
Abstract
The pancreaticobiliary system is a complex and vulnerable anatomic region. Small changes can lead to severe complications. Pancreaticobiliary disorders leading to severe complications include malignancies, pancreatitis, duodenal ulcer, duodenal diverticula, vascular malformations, and iatrogenic or traumatic injuries. Different therapeutic strategies, such as conservative, interventional (e.g., embolization, stent graft applications, or biliary interventions), or surgical therapy, are available in early disease stages. Therapeutic options in patients with severe complications such as duodenal perforation, acute bleeding, or sepsis are limited. If less invasive procedures are exhausted, an emergency pancreaticoduodenectomy (EPD) can be the only option left. The aim of this study was to analyze a single-center experience of EPD performed for benign non-trauma indications and to review the literature concerning EPD. Between January 2015 and January 2022, 11 patients received EPD due to benign non-trauma indications at our institution. Data were analyzed regarding sex, age, indication, operative parameters, length of hospital stay, postoperative morbidity, and mortality. Furthermore, we performed a literature survey using the PubMed database and reviewed reported cases of EPD. Eleven EPD cases due to benign non-trauma indications were analyzed. Indications included peptic duodenal ulcer with penetration into the hepatopancreatic duct and the pancreas, duodenal ulcer with acute uncontrollable bleeding, and penetration into the pancreas, and a massive perforated duodenal diverticulum with peritonitis and sepsis. The mean operative time was 369 min, and the median length of hospital stay was 35.8 days. Postoperative complications occurred in 4 out of 11 patients (36.4%). Total 90-day postoperative mortality was 9.1% (1 patient). We reviewed 17 studies and 22 case reports revealing 269 cases of EPD. Only 20 cases of EPD performed for benign non-trauma indications are reported in the literature. EPD performed for benign non-trauma indications remains a rare event, with only 31 reported cases. The data analysis of all available cases from the literature revealed an increased postoperative mortality rate of 25.8%. If less invasive approaches are exhausted, EPD is still a life-saving procedure with acceptable results. Performed by surgeons with a high level of experience in hepatobiliary and pancreatic surgery, mortality rates below 10% can be achieved.
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Affiliation(s)
- Maximilian Fickenscher
- Department of General-, Visceral- and Thoracic Surgery, Sana Hospital Hof, 95032 Hof, Germany
| | - Oleg Vorontsov
- Department of General-, Visceral- and Thoracic Surgery, Sana Hospital Hof, 95032 Hof, Germany
| | - Thomas Müller
- Department of Gastroenterology, Sana Hospital Hof, 95032 Hof, Germany
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, Sana Hospital Hof, 95032 Hof, Germany
| | - Christian Graeb
- Department of General-, Visceral- and Thoracic Surgery, Sana Hospital Hof, 95032 Hof, Germany
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Operative Re-Intervention following Pancreatoduodenectomy: What Has Changed over the Last Decades. J Clin Med 2022; 11:jcm11247512. [PMID: 36556127 PMCID: PMC9782126 DOI: 10.3390/jcm11247512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background: To investigate changes over the last decades in the management of postoperative complications following pancreatoduodenectomy (PD) with special emphasis on reoperations, their indications, and outcomes. Methods: 409 patients who underwent PD between 2008 and 2021 were retrospectively analyzed with respect to their need for reoperations (reoperation, n = 81, 19.8% vs. no reoperation, n = 328, 80.2%). The cohort was then compared to a second cohort comprising patients who underwent PD between 1989 and 2007 (n = 285). Results: 81 patients (19.8%) underwent reoperation. The main cause of reoperation was the dehiscence of pancreatogastrostomy (22.2%). Reoperation was associated with a longer duration of the index operation, more blood loss, and more erythrocyte concentrates being transfused. Patients who underwent reoperation showed more postoperative complications and a higher mortality rate (25% vs. 2%, p < 0.001). Compared to the earlier cohort, the observed increase in reoperations did not lead to increased mortality (5% vs. 6%, p = 353). Conclusions: The main cause for reoperation has changed over the last decades and was the dehiscence of pancreatogastrostomy. Associated with a leakage of pancreatic fluid and clinically relevant PF, it remains the most devastating complication following PD. Strategies for prevention and treatment, e.g., by endoscopic vacuum-assisted-closure therapy are of utmost importance.
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Popa C, Schlanger D, Chirică M, Zaharie F, Al Hajjar N. Emergency pancreaticoduodenectomy for non-traumatic indications—a systematic review. Langenbecks Arch Surg 2022; 407:3169-3192. [DOI: 10.1007/s00423-022-02702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
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Alzerwi N. Post-bulbar duodenal ulcer with anterior perforation with kissing ulcer and duodenocaval fistula: A case report and review of literature. World J Clin Cases 2022; 10:9071-9077. [PMID: 36157647 PMCID: PMC9477055 DOI: 10.12998/wjcc.v10.i25.9071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/27/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A post-bulbar duodenal ulcer (PBDU) is an ulcer in the duodenum that is distal to the duodenal bulb. PBDU may coexist with a synchronous posterior ulcer in rare occurrences, resulting in a kissing ulcer (KU). Duodenocaval fistula (DCF) is another uncommon but potentially fatal complication related to PBDU. There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.
CASE SUMMARY A 22-year-old man was admitted to the emergency department with abdominal pain, stiffness, and vomiting. The X-ray showed pneumoperitoneum, suggesting a perforated viscus. Laparotomy revealed a KU with anterior perforation and a DCF. After Kocherization, venorrahphy was used to control caval bleeding. Due to the critical condition of the patient, only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy. However, later, the patient developed obstructive jaundice and leakage, and two additional jejunal perforations were detected. Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer, neither primary repair nor pancreatic-free duodenectomy and ampulloplasty/ampullary reimplantation were considered viable; therefore, an emergency pancreaticoduodenectomy was performed, along with resection and anastomosis of the two jejunal perforations. The patient had a smooth recovery after surgery and was discharged after 27 d.
CONCLUSION The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients, even in the most complex cases.
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Affiliation(s)
- Nasser Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Riyadh 66, Riyadh , Saudi Arabia
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Schlanger D, Popa C, Ciocan A, Șofron C, Al Hajjar N. Emergency Pancreatoduodenectomy: A Non-Trauma Center Case Series. J Clin Med 2022; 11:jcm11102891. [PMID: 35629017 PMCID: PMC9143146 DOI: 10.3390/jcm11102891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/21/2022] Open
Abstract
(1) Background: Emergency pancreatoduodenectomy (EPD) is a rare procedure, especially in non-trauma centers. Pancreatoduodenectomy is a challenging intervention, that has even higher risks in emergency settings. However, EPD can be a life-saving procedure in selected cases. (2) Methods: Our study is a single-center prospective consecutive case series, on patients that underwent emergency pancreatoduodenectomies in our surgical department between January 2014 to May 2021. (3) Results: In the 7-year period, 4 cases were operated in emergency settings, out of the 615 patients who underwent PD (0.65%). All patients were male, with ages between 44 and 65. Uncontrollable bleeding was the indication for surgery in 3 cases, while a complex postoperative complication was the reason for surgery in one other case. In three cases, a classical Whipple procedure was performed, and only one case had a pylorus-preserving pancreatoduodenectomy. The in-hospital mortality rate was 25% and the morbidity rate was 50%; the two patients that registered complications also needed reinterventions. The patients who were discharged had a good long-term survival. (4) Conclusion: EPD is a challenging procedure, rare encountered in non-traumatic cases, that can be a life-saving intervention in well-selected cases, offering good long-term survival.
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Affiliation(s)
- Diana Schlanger
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Călin Popa
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-074-357-8432
| | - Andra Ciocan
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Cornelia Șofron
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
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Varshney VK, Nayar R, Sreesanth KS, Soni S, Varshney B. Emergency Pancreatoduodenectomy for Ampullary Cancer Post-Iatrogenic Duodenal Perforation: No Option but to Strike. Cureus 2020; 12:e11384. [PMID: 33312785 PMCID: PMC7725210 DOI: 10.7759/cureus.11384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Endoscopic retrograde cholangiography related duodenal perforation is an infrequent complication and associated with significant morbidity. The management of such perforations, especially in the setting of malignancy, is not standardized given the paucity of literature. We encountered a patient who was diagnosed with periampullary carcinoma and had a perforation in the duodenum during endoscopy. Emergency pancreatoduodenectomy (EPD) was performed considering it to be a resectable disease with minimal contamination. He had a prolonged hospital course due to surgical site infection and hepaticojejunostomy leak, however, which was managed successfully. At one year follow up, he is healthy with no evidence of recurrence. We conclude that EPD can be attempted for selected iatrogenic duodenal perforations with co-existent resectable malignancy in a stable patient. It may help to avoid the morbidity of a second surgery in the setting of a distorted anatomy and simultaneously preventing the probable upstaging of disease due to peritoneal seedling.
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Affiliation(s)
- Vaibhav K Varshney
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Raghav Nayar
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Kelu S Sreesanth
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Subhash Soni
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Bharti Varshney
- Pathology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
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11
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Kazi M, Shrikhande SV, Chaudhari VA, Kurunkar S, Bhandare MS. Emergency Radical Gastrectomy with Pancreatico-duodenectomy for a Recent Onset Perforation of Locally Advanced Gastric Cancer with Pancreatic Head Involvement-Exceptional but a Definite Option. Indian J Surg Oncol 2020; 11:278-281. [PMID: 33364719 DOI: 10.1007/s13193-020-01189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022] Open
Abstract
Gastric cancer perforations are rare events with management options ranging from lavage and perforation closure, to resection. Usual aim is to perform a damage control procedure, and very few patients are suitable for a curative resection. We report the first case of emergency gastrectomy with pancreatico-duodenectomy performed in emergency for a perforated stomach cancer with pancreatic head invasion. The patient was a 32-year-old gentleman who presented with a perforated antro-pyloric cancer with infiltration of pancreatic head. Emergency radical gastrectomy with en-bloc pancreatico-duodenectomy was performed with due considerations to the patient and disease factors. He had an uneventful postoperative recovery and remains disease free at 18 months of follow-up after having received adjuvant chemotherapy. Curative resections should be selectively offered in advanced (T4b) gastric cancers in patients without multiple adverse factors. In an emergency situation with perforation peritonitis, if the magnitude of resection is deemed unlikely to add to significant morbidity of the surgery, taking multiple factors into consideration, an R0 resection can offer a large survival benefit in such settings.
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Affiliation(s)
- Mufaddal Kazi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | - Vikram A Chaudhari
- Department Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra 400012 India
| | - Sagar Kurunkar
- Apple Saraswati Multi-specialty Hospital, Kolhapur, India
| | - Manish S Bhandare
- Department Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra 400012 India
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12
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Driedger MR, Puig CA, Thiels CA, Bergquist JR, Ubl DS, Habermann EB, Grotz TE, Smoot RL, Nagorney DM, Cleary SP, Kendrick ML, Truty MJ. Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients. BMC Surg 2020; 20:169. [PMID: 32718311 PMCID: PMC7385869 DOI: 10.1186/s12893-020-00822-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/10/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND While emergent pancreatic resection for trauma has been previously described, no large contemporary investigations into the frequency, indications, and outcomes of emergent pancreatectomy (EP) secondary to complications of neoplastic disease exist. Modern perioperative outcomes data are currently unknown. METHODS ACS-NSQIP was reviewed for all non-traumatic pancreatic resections (DP - distal pancreatectomy, PD - pancreaticoduodenectomy, or TP- total pancreatectomy) in patients with pancreatico-biliary or duodenal-ampullary neoplasms from 2005 to 2013. Patients treated for complications of pancreatitis were specifically excluded. Emergent operation was defined as NSQIP criteria for emergent case and one of the following: ASA Class 5, preoperative ventilator dependency, preoperative SIRS, sepsis, or septic shock, or requirement of > 4 units RBCs in 72 h prior to resection. Chi-square tests, Fisher's exact tests were performed to compare postoperative outcomes between emergent and elective cases as well as between pancreatectomy types. RESULTS Of 21,452 patients who underwent pancreatectomy for neoplastic indications, we identified 534 (2.5%) patients who underwent emergent resection. Preoperative systemic sepsis (66.3%) and bleeding (17.9%) were most common indications for emergent operation. PD was performed in 409 (77%) patients, DP in 115 (21%), and TP in 10 (2%) patients. Overall major morbidity was significantly higher (46.1% vs. 25.6%, p < 0.001) for emergent vs. elective operations. Emergent operations resulted in increased transfusion rates (47.6% vs. 23.4%, p < 0.001), return to OR (14.0% vs. 5.6%, p < 0.001), organ-space infection (14.6 vs. 10.5, p = 0.002), unplanned intubation (9.% vs. 4.1%, p < 0.001), pneumonia (9.6% vs. 4.2%, p < 0.001), length of stay (14 days vs. 8 days, p < 0.001), and discharge to skilled facility (31.1% vs. 13.9%). These differences persisted when stratified by pancreatic resection type. The 30-day operative mortality was higher in the emergent group (9.4%vs. 2.7%, p < 0.001) and highest for emergent TP (20%). CONCLUSION Emergent pancreatic resection is markedly uncommon in the setting of neoplastic disease. Although these operations result in increased morbidity and mortality compared to elective resections, they can be life-saving in specific circumstances. The results of this large series of modern era national data may assist surgeons as well as patients and their families in making critical decisions in select cases of acutely complicated neoplastic disease.
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Affiliation(s)
- Michael R Driedger
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Carlos A Puig
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cornelius A Thiels
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - John R Bergquist
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Daniel S Ubl
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Research and Policy, Mayo Clinic, Rochester, MN, USA
| | - Travis E Grotz
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rory L Smoot
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David M Nagorney
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael L Kendrick
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mark J Truty
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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13
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Nentwich MF, Reeh M, Uzunoglu FG, Bachmann K, Bockhorn M, Izbicki JR, Vashist YK. Non-trauma Emergency Pancreatoduodenectomies: A Single-Center Retrospective Analysis. World J Surg 2017; 40:2261-6. [PMID: 27138883 DOI: 10.1007/s00268-016-3525-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To retrospectively assess the frequency and indications for emergency pancreatoduodenctomies in a tertiary referral center. METHODS Pancreatoduodenectomies between January 2005 and January 2014 were retrospectively assessed for emergency indications defined as surgery following unplanned hospital admission in less than 24 h. Data on indications and on the intraoperative as well as the post-operative course were collected. RESULTS Out of 583 pancreatoduodenectomies during the interval, a total of 10 (1.7 %) were performed as an emergency surgery. Indications included uncontrollable bleeding, duodenal and proximal jejunal perforations, and endoscopic retrograde cholangiopancreatography-related complications. Three of the 10 (30.0 %) patients died during the hospital course. In one patient, an intraoperative mass transfusion was necessary. No intraoperative death occurred. All but one patient were American Society of Anesthesiologists class three or higher. In two cases, the pancreatic remnant was left without anastomosis for second-stage pancreatojejunostomy. Median operation time was 326.5 min (SD 100.3 min). Hospital stay of the surviving patients was prolonged (median 43.0 days; SD 24.0 days). CONCLUSION Emergency pancreatoduodenectomies are non-frequent, have a diverse range of indications and serve as an ultima ratio to cope with severe injuries and complications around the pancreatic head area.
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Affiliation(s)
- Michael F Nentwich
- Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - M Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - F G Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - K Bachmann
- Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Bockhorn
- Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - J R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Y K Vashist
- Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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14
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Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery. Gastroenterol Res Pract 2017; 2017:2036951. [PMID: 28757865 PMCID: PMC5512028 DOI: 10.1155/2017/2036951] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/01/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. METHODS From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34-82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57-70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. RESULTS All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14-23). CONCLUSION Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.
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15
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Tsai CY, Lai BR, Wang SY, Liao CH, Liu YY, Kang SC, Yeh CN, Jan YY, Yeh TS. The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients. World J Emerg Surg 2017; 12:21. [PMID: 28469698 PMCID: PMC5414322 DOI: 10.1186/s13017-017-0133-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/25/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Emergent pancreaticoduodenectomy is a life-saving procedure in certain clinical scenarios when all the conservative treatment fails. The indications can be limited into perforation and bleeding. To clarify the impact of etiology on surgical outcomes of emergent pancreaticoduodenectomy for non-trauma, we analyzed our patients and performed a literature review. METHODS We reviewed 931 consecutive pancreaticoduodenectomies performed at our institute between January 2001 and July 2015. Patients with emergent pancreaticoduodenectomy for non-trauma etiologies were enrolled, whereas those who suffered from caustic injuries were excluded. The keywords "emergent/emergency" and "pancreaticoduodenectomy/pancreatoduodenectomy" were applied in a literature search. The universally available data for all the enrolled patients including etiology, surgical complications, outcomes, and hospital stays were analyzed. Univariate and multivariate logistic analysis for the contributing factors to surgical mortality were performed. RESULTS Six out of 931 (0.6%) registered pancreaticoduodenectomies matched our criteria of inclusion. The literature review obtained 4 series and 7 case reports, which when combined with our patients yielded a cohort of 31 emergent pancreaticoduodenectomies with 13 cases of perforation and 18 of bleeding. The rate of emergent pancreaticoduodenectomy for non-traumatic etiologies is similar between the present study and the other 3 series, ranging from 0.3 to 3%. The overall surgical complication rate was 83.9%. The rate of surgical mortality is significantly higher than in elective pancreaticoduodenectomy by propensity score matching with age and gender (19.4 versus 3.2%, P = 0.015). Univariate and multivariate logistic regression disclosed that etiology is the only preoperative risk factor for surgical mortality (perforation versus bleeding; odds ratio = 39.494, P = 0.031). CONCLUSIONS Emergent pancreaticoduodenectomy remains a rare operation. Surgical morbidity and mortality are higher than with elective pancreaticoduodenectomy among different reported series. By sorting the preoperative etiologies into two groups, perforation carries a higher risk of surgical mortality than bleeding.
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Affiliation(s)
- Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Bo-Ru Lai
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Shang-Yu Wang
- Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan.,Department of Traumatology and Emergent Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan
| | - Chien-Hung Liao
- Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan.,Department of Traumatology and Emergent Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan
| | - Yu-Yin Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Shih-Ching Kang
- Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan.,Department of Traumatology and Emergent Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Yi-Yin Jan
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
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16
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Lissidini G, Prete FP, Piccinni G, Gurrado A, Giungato S, Prete F, Testini M. Emergency pancreaticoduodenectomy: When is it needed? A dual non-trauma centre experience and literature review. Int J Surg 2015; 21 Suppl 1:S83-S88. [PMID: 26130436 DOI: 10.1016/j.ijsu.2015.04.096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 03/27/2015] [Accepted: 04/10/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Emergency pancreaticoduodenectomy (EPD) has been very rarely reported in literature as a lifesaving procedure for complex pancreatic injury, uncontrollable hemorrhage from ulcers and tumors, descending duodenal perforations, and severe infection. The aim of this study was to analyze the experience of two non-trauma centers and to review the literature concerning emergency pancreaticoduodenectomy. METHODS From January 2005 to December 2014, from a population of 169 PD (92 females and 77 males; mean age: 61.3, range 23-81) 5 patients (3%; 2 females and 3 males; mean age: 57.8, range: 42-74) underwent EPD for non-traumatic disease performed at two Academic Units of the University of Bari. RESULTS The emergency pancreaticoduodenectomy subgroup of patients showed an overall morbidity of 80%, and mortality of 40%. In 80% (4/5) of patients treated by emergency pancreaticoduodenectomy, the pancreatic remnant was not reconstructed, and in 20% (1/5) a pancreaticojejunostomy was performed. CONCLUSION Emergency pancreaticoduodenectomy is an effective life-saving operation reservable to pancreatoduodenal trauma, perforations, and bleeding, unmanageable by a less invasive approach. It should be preferentially approached by surgeons with a high level of experience in hepatobiliary and pancreatic surgery and in trauma centers too, but it should also be in the armamentarium of general surgeons performing hepato-pancreato-biliary surgery.
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Affiliation(s)
- Germana Lissidini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
| | - Francesco Paolo Prete
- Unit of Videolaparoscopic Surgery, Department of Emergency Surgery and Organs Transplantation, University of Bari, Italy.
| | - Giuseppe Piccinni
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
| | - Angela Gurrado
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
| | - Simone Giungato
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
| | | | - Mario Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
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17
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Strobel O, Schneider L, Philipp S, Fritz S, Büchler MW, Hackert T. Emergency pancreatic surgery--demanding and dangerous. Langenbecks Arch Surg 2015; 400:837-41. [PMID: 26149078 DOI: 10.1007/s00423-015-1321-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 06/25/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Elective pancreatic surgery can be carried out with mortality rates below 5% in specialized centers today. Only few data exist on pancreatic resections in emergency situations. The aim of the study was to characterize indications, procedures, and outcome of emergency pancreatic surgery in a tertiary center. METHODS Prospectively collected data of all patients undergoing pancreatic operations at the authors' institution between October 2001 and December 2012 were analyzed regarding primary emergency operations in terms of indications, procedures, perioperative complications, and outcome. Emergency operations after preceding resections were excluded from the analysis. RESULTS Twenty-three emergency operations were performed during the observation period. Indications were duodenal perforation (n = 8), upper GI bleeding (n = 6), complicated pseudocysts (n = 3), bile duct perforation (n = 2), pancreatic bleeding after blunt abdominal trauma (n = 1), pancreatic stent perforation (n = 1), necrotizing cholecystitis (n = 1), and ileus (n = 1). Procedures included partial and total duodeno-pancreatectomy (n = 15), cystojejunostomy (n = 2), distal pancreatectomy (n = 4), reconstruction of the ampulla Vateri (n = 1), and duodenectomy (n = 1). Median intraoperative blood loss was 750 (200-2500) ml and OP time 4.25 (1.75-9.25) h. Mean ICU stay was 21.3 (1-80) days with an overall surgical morbidity of 52.2%. Overall in-hospital mortality was 34.8% (8/23 pat.). CONCLUSIONS Emergency pancreatic operations are infrequent and mainly performed due to duodenal perforation or bleeding; blunt abdominal trauma is rarely leading to emergency pancreas resections. They are associated with an increased morbidity and mortality and require a high level of surgical as well as interdisciplinary experience. Perioperative anesthesiological care and interventional radiological complication management are essential to improve outcome in this selective patient collective.
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Affiliation(s)
- Oliver Strobel
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Lutz Schneider
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Sebastian Philipp
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Stefan Fritz
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thilo Hackert
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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18
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Gulla A, Tan WP, Pucci MJ, Dambrauskas Z, Rosato EL, Kaulback KR, Pundzius J, Barauskas G, Yeo CJ, Lavu H. Emergent pancreaticoduodenectomy: a dual institution experience and review of the literature. J Surg Res 2014; 186:1-6. [PMID: 24011528 DOI: 10.1016/j.jss.2013.07.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Emergent pancreaticoduodenectomy (EPD) is an uncommon surgical procedure performed to treat patients with acute pancreaticoduodenal trauma, bleeding, or perforation. This study presents the experience of two university hospitals with EPD. METHODS Clinical data on EPD in trauma and nontrauma patients from 2002-2012 were extracted from the hepatopancreatobiliary surgery databases at Thomas Jefferson University and Kaunas Medical University Hospitals. Data on indications, perioperative variables, morbidity, and mortality rates were evaluated. RESULTS Ten single-stage EPD patients were identified. Five underwent a classic Whipple resection, whereas five had pylorus preservation. Seven patients had traumatic indications for pancreaticoduodenectomy: three from gunshot wounds to the abdomen and four from blunt high-energy injuries (two sustained injuries by falling from height and two by direct assaults on the abdomen). Three cases of nontrauma patients had EPD surgery for massive gastrointestinal hemorrhage. The median age of the EPD cohort was 46 y (range, 19-67 y). All 10 patients were recovered and were discharged from the hospital with a median postoperative length of stay of 24 d (range, 8-69 d). There were no perioperative mortalities. CONCLUSIONS Despite a high morbidity rate and prolonged recovery, this dual institutional review suggests that EPD can serve as a lifesaving procedure in both the trauma and the urgent nontrauma settings.
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Affiliation(s)
- Aiste Gulla
- Department of Surgery, Kaunas Clinics, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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19
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A case of upper gastrointestinal acute bleeding as a complication of renal carcinoma metastases to the papilla Vateri. Contemp Oncol (Pozn) 2013; 17:470-2. [PMID: 24596540 PMCID: PMC3934032 DOI: 10.5114/wo.2013.37226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/02/2012] [Accepted: 05/10/2012] [Indexed: 11/17/2022] Open
Abstract
Acute bleeding from metastatic tumour of the papilla Vateri is an extremely rare case. In this report the case of a woman who suffered from complications after a metastatic tumour of the papilla is described. Seventeen years following resection of the kidney due to clear cell carcinoma the patient was admitted to the clinic because of massive bleeding (Forrest IB) to the upper digestive tract in the form of sanguineous vomiting. The conducted diagnostics revealed a bleeding tumour of the papilla Vateri. Endoscopic treatment could not effectively stop the bleeding. A surgical procedure was performed by Whipple's method. A histopathological examination showed a metastatic clear cell tumour of the kidney. The patient was discharged from hospital on the 8th day following her admission and was also referred for further oncological treatment. The discussion is based on other cases of rare bleeding from the digestive tract within tumours of the bile duct and papilla Vateri.
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