Ulus Travma Acil Cerrahi Derg. Baskýdaki Makaleler: UTD-59829

Multiorgan Yaralanmasý Olan Hastada Travmatik Pankreas-Duodenum Ayrýlmasý için Acil Whipple Prosedürü: Bir Olgu Sunumu ve Derleme

Burak Þakar, Nuri Berk Konuk, Duygu Dikici, Arif Aslaner, Kemal Eyvaz
Saðlýk Bilimleri Üniversitesi, Antalya Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Antalya, Türkiye

Pankreatikoduodenal travmalar nadir görülmekle birlikte, yüksek morbidite ve mortalite riski taþýyan komplike cerrahi durumlar arasýnda yer almaktadýr. Bu olgu sunumunda, acil servise yüksekten düþme nedeniyle getirilen ve yapýlan görüntülemelerinde batýn içinde serbest hava ve serbest sývý ile birlikte sað böbrekte perfüzyon kaybý dahil multiorgan yaralanmasý saptanan 17 yaþýndaki erkek hastaya uygulanan acil pankreatikoduodenektomi (Whipple prosedürü) sunulmaktadýr. Hastaya yapýlan acil cerrahi eksplorasyonda; Grade V düzeyinde pankreas baþý avülsiyonu, distal safra yolu hasarý, duodenal laserasyon, transvers kolonun proksimal üçte birlik kýsmýnda laserasyon ve sað böbrek devaskülarizasyonu tespit edilmiþtir. Hastanýn intraoperatif hemodinamik stabilitesi göz önünde bulundurularak Whipple prosedürü, segmenter kolon rezeksiyonu ve anastomoz ile birlikte sað nefrektomi gerçekleþtirilmiþtir. Postoperatif 11. günde hastada kolokolonik anastomoz hattýnda kaçak geliþmiþ olup, acil cerrahi giriþimle sað hemikolektomi ve uç ileostomi uygulanmýþtýr. Takip süresince hastada genel cerrahi açýsýndan ek bir acil cerrahi müdahale gereksinimi olmamýþtýr. Bu olgu, yüksek riskli travmalarda multidisipliner ekip çalýþmasý ve hastanýn klinik durumuna göre bireyselleþtirilmiþ cerrahi kararlarýn önemini vurgulamaktadýr. Kompleks anatomik hasarlarýn varlýðýnda, uygun cerrahi zamanlamanýn belirlenmesi, doðru teknik seçimi ve komplikasyonlarýn yönetimi, tedavi baþarýsýnda belirleyici rol oynamaktadýr. Bu kapsamda, cerrahi yaklaþým ve zamanlama, güncel literatür eþliðinde tartýþýlmýþ ve benzer olgularla karþýlaþtýrmalý olarak deðerlendirilmiþtir.

Anahtar Kelimeler: Pankreas travmasý, Duodenum yaralanmasý, Whipple prosedürü, Acil cerrahi, Multiorgan yaralanma

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Emergency Whipple Procedure for Traumatic Pancreas–Duodenum Separation in a Patient with Multiorgan Injury: A Case Report and Review

Burak Þakar, Nuri Berk Konuk, Duygu Dikici, Arif Aslaner, Kemal Eyvaz
Department Of General Surgery, University Of Health Sciences, Antalya Training And Research Hospital, Antalya, Türkiye

Although pancreaticoduodenal injuries are rare, they represent complex surgical conditions associated with high risks of morbidity and mortality. This case report presents an emergency pancreaticoduodenectomy (Whipple procedure) performed on a 17-year-old male patient who was admitted to the emergency department following a fall from height, with imaging studies revealing free intraperitoneal air and fluid, as well as multiorgan injury, including right renal perfusion loss. Emergency surgical exploration revealed a Grade V pancreatic head avulsion, distal bile duct injury, duodenal laceration, a laceration in the proximal one-third of the transverse colon, and right renal devascularization. Considering the patient’s intraoperative hemodynamic stability, a Whipple procedure, segmental colectomy with primary anastomosis, and right nephrectomy were performed. On postoperative day 11, a leak developed at the colocolonic anastomosis site, and the patient underwent emergency surgery involving right hemicolectomy and end ileostomy. During the follow-up period, no additional emergency surgical intervention was required from a general surgery perspective. This case highlights the importance of multidisciplinary team collaboration and individualized surgical decision-making in the management of high-risk trauma based on the clinical condition of the patient. In the presence of complex anatomical injuries, the determination of appropriate surgical timing, the selection of optimal techniques, and the management of complications play a decisive role in treatment success. In this context, the surgical approach and timing were discussed in light of the current literature and evaluated in comparison with similar cases.

Keywords: Pancreatic trauma, Duodenal injury, Whipple procedure, Emergency surgery, Multiorgan injury

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