Two-stage trauma pancreaticoduodenectomy: delay facilitates anastomotic reconstruction

A case of a gunshot wound to the head of the pancreas and superior mesenteric vein requiring pancreaticoduodenectomy is discussed. Managing such an injury is challenging, first because of the ongoing hemorrhage and second because of the technical difficulty in working with a normal pancreas and bile duct. In the case presented herein, enteric reconstruction was performed 72 hours after the initial surgery. A delay in reconstruction resulted in tissue changes that facilitated enteric reconstruction. A two-stage pancreaticoduodenectomy may be considered if the surgeon is faced with an unstable patient.