We report 2 cases of two-stage pancreatoduodenectomy for injuries to the pancreatic head, in which the pancreatojejunostomy was performed first. Case #1 was caused by a traffic accident and case #2 by a blow to the abdomen. Both injuries to the pancreatic head were classified as American Association for the Surgery of Trauma Organ Injury Score grade V. In the initial surgeries, all the reconstruction modalities except for cholangiojejunostomy were performed. A modification of Child’s method was used for the reconstruction. The pancreatic duct was converted into an incomplete external drainage. A complete drainage tube was inserted into the common hepatic duct via the liver, and the stump was sutured and closed. The bile duct and jejunum were sutured for anastomosis in stage 2. In this stage, only cholangiojejunostomy was performed. Only the anterior half circumferences of the bile duct and jejunum were anastomosed. Both patients survived and experienced no complications.
Shinjiro Kobayashi, Kohei Segami, Hiroyuki Hoshino, Masafumi Katayama, Satoshi Koizumi, Takehito Otsubo