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

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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