Emergency pancreaticoduodenectomy for traumatic pancreaticoduodenal injury with celiac axis stenosis

Abstract

Abstract Emergency pancreaticoduodenectomy (PD) for trauma is technically demanding, and unrecognized celiac axis stenosis (CAS) may compromise hepatic arterial inflow after gastroduodenal artery (GDA) division. A 59-year-old man presented in hemorrhagic shock after blunt abdominal trauma. Computed tomography demonstrated destructive pancreaticoduodenal injury, active bleeding, and proximal CAS with a hooked configuration suggesting median arcuate ligament (MAL) compression. After inferior pancreaticoduodenal arterial embolization, superior mesenteric arteriography showed retrograde filling of the celiac territory. Persistent hemodynamic instability necessitated emergency laparotomy and PD. Temporary GDA clamping markedly weakened common hepatic artery pulsation, confirming collateral-dependent hepatic arterial inflow. MAL release promptly restored pulsation, allowing PD with immediate reconstruction. The patient was discharged on postoperative day 34. In emergency PD for trauma, CAS or retrograde celiac filling should prompt temporary GDA clamping before irreversible division to guide MAL release or another inflow-preserving strategy.