| 摘要 |
A major pancreatic trauma challenges the trauma surgeon with diagnostic problems and the choice of treatment modalities. Assessment of the integrity of the pancreatic ductal system after a penetrating injury is mandatory to help prevent potentially fatal complications. We report here the use of a catheter for transpapollary wirsungogtaphy intraoperatively to assess ductal integrity after a pancreatic head gunshot wound, together with the successful postoperative management of ductal stricture by endoscopic retrograde stenting technique. A 21-year-old soldier suffered a penetrating abdominal injury from a self-inflicted high velocity bullet through hepatic segment IV, the first portion of duodenum, and the pancreatic head, together with comminured fractures of L2-L3 vertebral bodies, and spinal cord thermal damage. Intraoperative pancreatography showed no obvious pancreatic duct disruption, therefore adequste debridement of devitalized tissue of pancreatic head and duodenum, peri-pancreatic drainage and feeding jejunostomy were done. Postoperative endoscopic placement of a 7Fr plastic pancreatic stent in Wirsung’s duct was repeatedly done to prevent long-term ductal stenosis. |
