Complete duodenal necrosis associated with non-traumatic duodenal hematoma requiring emergent pancreatico-duodenectomy.

Autor:	Koichopolos J; Department of Surgery, London Health Sciences Center, London, ON, Canada; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. Electronic address: jenniferkoichopolos@gmail.com., Keow J; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Pathology, London Health Sciences Center, London, ON, Canada., Parfitt J; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Pathology, London Health Sciences Center, London, ON, Canada., Yoshy C; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Radiology, London Health Sciences Center, London, ON, Canada., Wiseman D; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Radiology, London Health Sciences Center, London, ON, Canada., Leslie K; Department of Surgery, London Health Sciences Center, London, ON, Canada; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Jazyk:	angličtina
Zdroj:	International journal of surgery case reports [Int J Surg Case Rep] 2020; Vol. 66, pp. 53-57. Date of Electronic Publication: 2019 Nov 19.
DOI:	10.1016/j.ijscr.2019.11.026
Abstrakt:	Introduction: Duodenal necrosis is a rare complication of acute pancreatitis but can occur given the shared blood supply to the head of the pancreas and the duodenum. Presentation of Case: A 55-year-old male presented with acute-on-chronic pancreatitis and a duodenal hematoma. The hematoma expanded to occlude the biliary tree and, shortly after, the duodenum necrosed and perforated. The patient required an emergent pancreaticoduodenectomy performed in two stages. Discussion: Surgical management is complex and a difficult challenge for a general surgeon. Many advocate for wide drainage to create a controlled fistula using a malecot through the wall defect/separate duodenotomy/a retrograde jejunostomy tube. This case represents an extreme variation on this issue which was best managed by definitive resection given the extent of the necrosis. Conclusion: This case report demonstrates that duodenal hematoma and necrosis should be recognized as part of the spectrum of consequences of acute pancreatitis. General surgeons should have a surgical approach to this complication whether that be diversion or definitive resection. Competing Interests: Declaration of Competing Interest No authors have conflicts, financial or personal relationships with other people or organizations that could influence our work. (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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