Emergency Kausch-Whipple Procedure Indications and Experiences
ABSTRACT Pancreaticoduodenectomy is a demanding procedure even in selected patients but becomes formidable when performed in cases of emergency. This study analyzed our experience with urgent pancreatoduodenectomies; special emphases were put on the evaluation of diagnostic means and the validation of existing indications for performance of this procedure.
Three hundred one patients who underwent pancreatoduodenectomy between 1989 and 2008 were identified from a pancreatic resection database and reviewed for emergency indications.
Six patients (2%) underwent emergency pancreatoduodenectomy. Indications included endoscopy-related perforation, postoperative complications, and uncontrollable intraduodenal tumor bleeding. Length of stay and occurrence of nonsurgical complications were increased in emergency compared with elective pancreatoduodenectomies. Although increased, no significant differences were found regarding mortality and surgery-related complications.
Indications for emergency pancreatoduodenectomies were based on clinical decisions rather than on radiologic diagnostics. Urgent pancreatic head resections may be considered as an option in selected patients if handling of local complications by interventional measures or limited surgery seems unsafe.
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ABSTRACT: Pancreaticoduodenectomy is infrequently performed inemergency, so much the less in lack of traumatic evidence.A rare vascular complication of the pancreatic pseudocyst,the pseudoaneurysm, presents as a pulsating malformationwhich may lead to life-threatening bleeding if left untreated.Its optimal treatment remains controversial. Most authorsagree that angioembolization is the first step to stabilize thepatientâs condition, with further surgery if such be the case.We herein report an unusual case of pancreatic head pseudocystcomplicated with a bleeding pseudoaneurysm arisingfrom the inferior pancreaticoduodenal artery, in a patientwith multiple comorbid conditions, common mesentery,hepatic artery variant and hemodynamic instability. Anemergency early retropancreatic approach pancreaticoduodenectomywas performed with uneventful immediateand long-term outcome. We highlight that emergency surgeryallowed both rapid control over the bleeding with hemostasisand removal of the pseudocyst. This is particularly relevant inhigh-risk patients in whom selective angioembolization is nomore of choice.Chirurgia (Bucharest, Romania: 1990) 108(6):910-914. · 0.78 Impact Factor
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ABSTRACT: 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. 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. 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. 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.Journal of Surgical Research 08/2013; DOI:10.1016/j.jss.2013.07.057 · 2.12 Impact Factor
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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 8(th) 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.Contemporary Oncology / Wspólczesna Onkologia 10/2013; 17(5):470-2. DOI:10.5114/wo.2013.37226 · 0.22 Impact Factor