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