Diagnosis and treatment of injury to choledocho-pancreatico-duodenal junction

PENG Bao-gang

Abstract：Injury to choledocho-pancreatico-duodenal junction is one of the most complicated situations in abdominal trauma. It is very difficult to deal with because of the common concomitant injuries to other organs and the absence of consensus regarding treatment of injuries to bile duct, pancreas, and duodenum. The diagnosis relies on the combined use of clinical symptoms, laboratory tests, imaging modalities and even exploratory laparotomy. For lesions involving a single organ or being very mild, stanch bleeding, primary repair and drainage are advocated. As for lesions involving two or more organs, or being serious, treatments tend to be complicated, sometimes even pancreatoduodenectomy (Whipple procedure). Studies show that the implementation of complicated operations, such as Whipple procedure, in primary treatment of acute injury is very dangerous and correlated with high postoperative mortality rate leading to the occurrence of the concept of damage control surgery. In short, injury to choledocho-pancreatico-duodenal junction is correlated with high perioperative complications and mortality rate. Accurate and timely diagnosis and effective treatment are very important. Proficiency in anatomy of choledocho-pancreatico-duodenal junction, clinical features of lesions, combined applications of imaging techniques (including CT, MRCP, ERCP), and the concept of damage control surgery into the decision-making, are of great significance to improve the prognosis of patients with injuries to choledocho-pancreatico-duodenal junction.