A 22-year-old man struck his upper abdomen on the steering wheel. He presents 18 hours later with severe epigastric pain radiating to the back. Serum amylase is markedly elevated and CT abdomen shows a complete transection of the pancreatic body anterior to the superior mesenteric vessels with no duct injury proximal to them. Haemodynamically stable, he is managed operatively. Which procedure is most appropriate?
- A Distal pancreatectomy with splenectomy ✓
- B Pancreaticoduodenectomy
- C External drainage of the transected ends only
- D Pyloric exclusion with gastrojejunostomy
Correct answer: A. Distal pancreatectomy with splenectomy
Explanation
Transection of the body of the pancreas to the left of the superior mesenteric vessels is treated by distal pancreatectomy, usually with splenectomy since the splenic vessels course along the gland. Pancreaticoduodenectomy is reserved for massive destruction of the pancreatic head and duodenum and carries high mortality. Simple drainage leaves a major duct leak and pancreatic fistula. Pyloric exclusion addresses combined duodenal and head injuries, not isolated body transection.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.