Complex polytrauma with pancreas, duodenal, colonic, and vascular injuries

Case contributed by Michael P Hartung


Construction equipment rollover accident

Patient Data

Age: 50 years
Gender: Male

Multiple left rib fractures. Mildly displaced sternal body fracture. Small left pneumothorax with chest tube in place. Extensive soft tissue gas along the right body wall into the groin. 

Laceration of the pancreas body/neck with hypoenhancement surrounding fluid. Hypo-absent enhancement of the duodenum with discontinuity with the proximal jejunum. Thickening and hypoenhancement of the proximal transverse colon. Pneumoperitoneum. Medium hemoperitoneum.

Infrarenal abdominal aortic intimal injury with a dissection flap extending into the common iliac arteries, with severe focal narrowing on the right and small amount of mural thrombus on the left. On coronal images, notice the beaded/accordion-appearance of the external iliac arteries indicating spasm or possible stretch injuries.

Case Discussion

Complex polytrauma with multiple injuries described. Notice how each of the window/level settings helps you to identify the variety of injuries. 

At surgery, they confirmed the following:

  • crush injury of the transverse colon
  • complex duodenal injury along its entire length with necrosis; transection at the ligament of Treitz
  • pancreas head injury with avulsion from the duodenum
  • infrarenal aortic dissection 

The patient underwent the following surgeries following this case:

Emergent surgery:

  • repair of infrarenal aortic dissection with patch angioplasty
  • segmental resection of transverse colon
  • oversew of significant injury of segments 2 and 3 of the duodenum and transection at the ligament of Treitz
  • pyloric exclusion 
  • placement of periduodenal and peripancreatic drains due to pancreatic head injury and avulsion from the duodenum
  • temporary abdominal closure 

Follow-up operation:

  • abdominal washout
  • completion right hemicolectomy with Ileocolic anastomosis
  • Whipple procedure

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