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社区一级创伤中心的创伤性惠普尔手术:一例病例报告。

Trauma Whipple at a community level 1 trauma center: a case report.

作者信息

Nicholson Jessica A, Nicholson Andrew G, Abd-El-Hafez Mahmoud K, Shah Pankti, Lieser Mark J, Chipko John M

机构信息

Menorah Medical Center Department of General Surgery Residency, HCA Midwest Healthcare System, 5721 W 119th St, Overland Park, KS 66209, United States.

Department of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO 64106, United States.

出版信息

J Surg Case Rep. 2025 Aug 29;2025(8):rjaf657. doi: 10.1093/jscr/rjaf657. eCollection 2025 Aug.

Abstract

The Whipple operation is oftentimes considered one of the most challenging and complex abdominal operations, usually reserved for duodenal and hepatopancreatobiliary malignancies. In cases of duodenal and/or pancreatic trauma with disruption of the biliary systems, a Whipple reconstruction can be performed. Such operative traumas are rare and carry with them a high level of morbidity and mortality. This case report presents a challenging 46-day clinical course of a 22-year-old African American female, who suffered multiple gunshot wounds, resulting in severe abdominal injuries. These injuries included a grade 3 duodenal injury, grade 4 pancreatic injury, and a grade 4 renal injury. The patient underwent a staged Whipple operation. Postoperative complications included pancreaticojejunostomy leak, feeding tube leak, and mesenteric bleeding, all of which required surgical and interventional radiology management. After a 46-day hospitalization, the patient was discharged to a rehab facility, achieving an impressive recovery 2 years post-surgery.

摘要

惠普尔手术通常被认为是最具挑战性和复杂性的腹部手术之一,通常用于治疗十二指肠和肝胰胆系统恶性肿瘤。在十二指肠和/或胰腺创伤合并胆道系统破裂的情况下,可以进行惠普尔重建手术。此类手术创伤罕见,且伴有高发病率和死亡率。本病例报告呈现了一名22岁非裔美国女性长达46天的具有挑战性的临床病程,她遭受了多处枪伤,导致严重腹部损伤。这些损伤包括3级十二指肠损伤、4级胰腺损伤和4级肾损伤。该患者接受了分期惠普尔手术。术后并发症包括胰空肠吻合口漏、饲管漏和肠系膜出血,所有这些都需要手术和介入放射学处理。经过46天的住院治疗,患者出院前往康复机构,并在术后2年实现了令人瞩目的康复。

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