부산대학교 도서관

A 39-year-old man was caught inside a concrete mixer machine and admitted to our hospital presenting with multiple thoracoabdominal trauma. We performed damage control surgery (DCS) to control the intra-abdominal hemorrhage. Although the retroperitoneal hematoma around the pancreas head and duodenum was observed, we could not find any evidence of pancreatic duct injury or duodenal perforation. Three days later, delayed duodenal perforation and necrosis occurred and we tried to perform pancreaticoduodenectomy (PD). However, we could not carry out all gastrointestinal reconstructions due to significant intestinal tract edema. We then inserted external pancreatic and biliary drainage catheters palliatively. Eighteen weeks later, we tried to perform delayed gastrointestinal reconstruction surgery. The stump of pancreas and common hepatic duct were covered with very firm scar tissue, which was difficult to peel. To avoid complications associated with postoperative pancreatic fistula (PF), we did not reconstruct but performed conversions from two external drainage catheters to internal drainage catheters. Due to this reconstruction method, the patient could avoid PF and was discharged from hospital. However, he frequently suffered from other complications including cholangitis and chronic pancreatitis. Therefore, we performed re-reconstruction surgery on the 591st day after his first admission. Although there have been reported cases of delayed gastrointestinal reconstruction after PD, the clinical course of this present case was rare, and we thought it should be recognized.