ABDOMINAL IMPALEMENT TRAUMA WITH EXTENSIVE DUODENOPANCREATIC INJURY: CASE REPORT AND DEFINITIVE SINGLE-STAGE APPROACH

Abstract

Pancreatic and duodenal injuries resulting from penetrating abdominal trauma are rare and associated with high morbidity and mortality, especially when multiple organs are involved. The classical approach often includes damage-control surgery with delayed reconstruction. This article reports the case of a 40-year-old previously healthy man who sustained abdominal impalement by a wooden fragment and was admitted hemodynamically stable three hours after the trauma. Laparotomy revealed transfixing gastric injuries, complete disruption of the first and second portions of the duodenum, and a grade IV pancreatic injury. A single-stage pancreaticoduodenectomy with Roux-en-Y reconstruction was performed, resulting in favorable progression and discharge on postoperative day 20. Although rare and associated with high morbidity, pancreaticoduodenectomy in trauma may be successful in stable patients and in well-equipped centers. This case reinforces the importance of individualized management and contributes to clearer protocols for the treatment of pancreatoduodenal trauma.