PMC5279907_01
(a) White arrow, hematoma around pancreas; black arrow, infarcted right kidney. (b) Arrow, hematoma and extravasation of contrast media (bleeding). (c) White arrow, normal parenchyma of pancreatic body; black arrow, transected space of pancreatic head.
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Abdominal computed tomography (CT) using contrast media revealed a massive pool of intra-abdominal blood and the extravasation of contrast media or hematoma around the pancreas head, duodenum and superior mesenteric vessels (Fig. 1a and b). The pancreatic parenchyma seemed to be transected (Fig. 1c).
Superior mesenteric artery (SMA) and vein (SMV) trunk are encircled by red and blue tape, respectively. Arrow, bleeding site clamped with forceps.
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A hemostatic clamp easily controlled the bleeding because the main trunk of the SMA or SMV was not affected (Fig. 2).
(a) Dotted line, horizontal transected space of pancreatic head. (b) Intraoperative cholangiographic findings. Arrow, transected space with forceps that is separate from duodenal papilla. (c) Resected lower pancreas and attached duodenum (horizontal portion). (d) Pancreatic stump was fixed with tight sutures. (e) Specimen of tissue after partial PD.
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The pancreatic head was lacerated and completely horizontally transected (Fig. 3a), but a pancreatic fistula was not remarkable. Thus the transected part was separated from the main pancreatic duct (Fig. 3b). As a result, the discontinuous lower pancreas and uncus was not supposed to need repair, but this part with the attached transverse duodenum was resected (Fig. 3c) and the transected stump of the pancreas was tightly sutured (Fig. 3d). Partial PD was then achieved (Fig. 3e).