Total pancreas-preserving pancreatic injury-site jejunostomy for traumatic pancreatic head injury with main pancreatic duct transection: feasibility and decision algorithm.

Background: Traumatic pancreatic head injury with complete main pancreatic duct (MPD) transection is rare and associated with high morbidity. For the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade IV injuries, pancreaticoduodenectomy is often considered the only definitive option; however, its invasiveness and risk of long-term endocrine and exocrine dysfunction create a major dilemma when pancreaticoduodenectomy may be disproportionate to the anatomic injury. Practical pancreas-preserving strategies remain poorly defined. Case presentation: A 25-year-old male sustained a self-inflicted stab wound causing hemorrhagic shock, generalized peritonitis due to gastric perforation, and AAST-OIS Grade IV pancreatic head injury with complete MPD transection. Initial management consisted of staged damage-control surgery with peri-pancreatic gauze packing and negative-pressure therapy for hemorrhage and contamination control. After physiological stabilization, delayed reconstruction was performed using total pancreas-preserving pancreatic injury-site jejunostomy (PP-PIJ), in which viable pancreatic tissue surrounding the injury site was anastomosed to a Roux-en-Y jejunal limb without pancreatic resection. The postoperative course was complicated by a subfascial abdominal wall abscess with wound dehiscence requiring drainage and abdominal wall re-closure; however, no pancreatic fistula or anastomotic failure occurred, and pancreatic function was preserved. Conclusions: This report describes the first adult application of PP-PIJ and proposes a pancreas-preserving reconstructive option for traumatic pancreatic head injury with MPD transection. Staged damage-control surgery may serve as a platform for delayed reconstruction. The accompanying decision algorithm may assist operative selection when pancreaticoduodenectomy may be disproportionate to the anatomic injury.