في حالة الحوادث والإصابة الشديدة للإثنا عشر ورأس البنكرياس قد يحتاج الجراح إلي غلق فتحة بواب المعدة وتوصيل المعدة بالأمعاء
Pyloric Exclusion with Gastrojejunostomy for combined injury to the head of the Pancreas and the Duodenum
A.
· For a complex combined injury to the head of the pancreas and duodenum, pyloric exclusion is performed to decrease the risk of a postoperative lateral duodenal fistula.
· After control of the injury of the duodenum and pancreas has been accomplished, a dependent gastrotomy is made in the antrum of the stomach.
· The pylorus is palpated and grasped with Babcock clamps and closed with a #1 polypropylene suture.
· Almost every suture tends to cut through the pylorus, and the gastroduodenal outlet reopens in 2 to 3 weeks.
B.
· Following closure of the pylorus, a dependent antecolic gastrojejunostomy is created at the gastrotomy site.
· Patient should be screened for the presence of Helicobacter pylori postoperatively and treated if positive.
TRAUMA, 9th ed, 2020
