Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft.

Abstract

Emergency pancreatico-duodenectomy(EPD) is a very rare procedure and few reports are present in medical literature. It is an uncommon approach, usually used for emergency surgical treatment of abdominal trauma that involves the head of the pancreas or the duodenum, but it is also a surgical tool for the treatment of ruptured aneurysms, bleeding pseudocysts, duodenal perforations, uncontrollable hemorrhage from ulcers and tumors, severe infectious complications of acute pancreatitis or endoscopic retrograde cholangiopancreatography related complications (1,2). It is rarely used as the first line of treatment in case of acute bleeding from arterial pseudoaneurysm of the cephalad region of the pancreas. We present the case of a bleeding pseudoaneurysm of the cefalic region of the pancreas in a young patient with previously undiagnosed chronic pancreatitis and with suspicion of a malignant process located in the head of the pancreas. We performed a pancreatico-duodenectomy with resection of superior mesenteric and portal vein with reconstruction using Gore-Tex vascular graft due to probable venous abutment. Postoperative course was without any major complications, only minor grad-I pancreatic fistula was present. We determine that EPD is a useful tool in the treatment of such cases. It can be used as a first line of treatment or secondary to endovascular stenting or embolization.