Traumatic horizontal transection of the pancreas

Abstract text (incl. references and figure legends)

A 27-year-old patient was presented with a recent history of falling from a 2m high ladder, landing on a steel stick that penetrated the abdomen. On examination, the abdomen was mildly distended, painful for palpation, and showed peritoneal irritation. The penetrating wound was 8cm long, transverse, with oozing blood. Laboratory results were significant for lymphocytosis and elevated transaminases. CT of the abdomen revealed a complete transection of the pancreatic head. Due to uncontrolled bleeding and hemorrhagic shock, our patient required initial surgical damage control. Urgent laparotomy initially revealed that the pancreas between the head and the body was entirely horizontally interrupted. Several extensive fluid collections were in front of the tail and body of the pancreas, between the stomach and the spleen. The distal part of the pancreas was resected and the stump sutured. The critical issue for our patient was that the main pancreatic duct was damaged, and postoperative pancreatic fistula from the stump was a concern. Drainage tubes were appropriately positioned, and octreotide was administered to reduce pancreatic juice production. Postoperative hospitalization was complicated with postoperative pancreatic fistula, leading to an extended hospital stay. After successful conservative treatment, the patient was discharged one month after surgery and has remained free of further postoperative complications. Horizontal transection of the pancreas is uncommon and difficult to repair under unstable, emergency conditions; the timing and the choice of the procedure might be difficult. We want to emphasize the importance of early intervention and damage control management protocol for avoiding delayed morbidity and mortality. Fig.1: Abdominal CT scan (coronal) showing complete transection of the pancreas and peripancreatic fluid collections (P-pancreas, S-stomach) Fig.2: Abdominal CT scan (axial) showing pancreatic transection along the thoracolumbar spine.

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