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LAPAROSCOPIC DISTAL PANCREATECTOMY FOR BLUNT INJURY TO THE PANCREAS.
Dr. Paul Sayad,, laparoscopy fellow at the Staten Island University Hopsital with Robert Cacchione, MD; George Ferzli, MD, FACS
is presenting a case of a 10 year old child who underwent a laparoscopic distal pancreatectomy following blunt abdominal trauma, after falling off his bicycle.
This is a 10 Year old boy who sustained a blunt abdominal injury, mainly in the left upper quadrant, caused by the handle bar of the bicycle from which he had fallen. He went home, but 12 hours later complained of nausea and severe abdominal pain. He was immidiately brought to the emergency room.
On admission he was afebril and hemodinamically stable. On physical examination there was epigastric tenderness with rebound on palpation. The WBC and hematocrit levels were normal, and serum amylase was 940. A computed tomography (CT) scan revealed some free fluid in the abdomen, and distal transection of the pancreas was strongly suspected. The boy was taken to the operating room for diagnostic laparoscopy. The pancreatic injury was confirmed, and a laparoscopic distal pancreatectomy was performed; the operative time was 90 minutes. Estimated blood loss was less than 50 cc. The post operative course was uneventful; the patient was started on regular diet on postoperative day 2 and discharge home on day 3.
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Trocars were placed as shown in this picture
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Exploration of the abdomen was performed in a systematically manner. A fairly amount of fluid was noted in the abdominal cavity. There was also saponification of the fat of the greater omentum. No injury to the samll bowel or to the colon was identify. However, there was a hematoma noted in the transverse mesocolon.
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The lesser sac was entered by opening the gastrocolic ligament exposing the posterior wall of the stomach and pancreas.
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At tear was noted in the pancreas between the body and the tail. There was also an significant hematoma overlying the pancreas
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A window behind the pancreas lateral to the inferior mesenteric vein was made to the position of an endo GI stapler. The distal pancreas was retreived from the abdomen using a specimen bag.
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The pancreas stump was secured with a running a non-absorbable suture
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A JP drain was left in the lesser sac and covered with omentum
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Laparoscopy.com would like to thank Dr. Dr. Paul Sayad, from the Staten Island University Hopsital for his video contribution.
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