Transduodenal Intraductal Cannulation for Traumatic Pancreatic Head Disruption Without Primary Repair of the Pancreatic Duct-Report of a Case

Various techniques of surgical management for traumatic disruption of the pancreatic head with ductal injury have been recommended. Our recent experience with successful restoration of continuity of the irreparably disrupted pancreatic duct using an intraductal catheteris presented. A 57-year-old man was admitted 16 hours after a steering-wheel injury to hisepigastrium. Severe epigastric pain, dyspnea, and laboratory findings prompted immediate laparotomy. Exploration revealed an isolated laceration of the pancreatic head which bared the superior mesenteric vein. The main pancreatic duct was disrupted with a 6-mm long ductal defect, though the posterior wall of the injured duct remained barely intact. A catheter was inserted, bridging the defect, and acting as a stent. It was brought out through the ampulla of Vater, and through the duodenal wall and abdominal wall to the outside. The postoperative course was complicated by a high-output pancreatic fistula through a Penrose drain which resolved spontaneously. After the catheter was removed, endoscopic retrograde pancreatography on the 96th postoperative day (19 days after removal of the catheter) demonstrated healing of the disrupted duct without loss of any part of the organ. This procedure can provide an injured pancreas with normal anatomy and normal endocrine and exocrine functions. This technique could be considered as a method of management in selected cases of pancreatic disruption with a defect of the pancreatic ductal wall.