Case Report: Robotic-assisted laparoscopic primary repair for pancreaticoduodenal grade V injury in a pediatric patient

Background: High-grade pancreatic injury is rare but associated with significant mortality and morbidity. There is no consensus on whether nonoperative or operative treatment could result in good clinical outcomes. Minimally invasive surgery has been introduced to manage cases of abdominal trauma, but no application in high-grade pancreaticoduodenal injury has been reported. Case presentation: An 8-year-old boy complained of severe abdominal pain after a bicycle injury. On admission, the patient was hemodynamically stable with elevated serum amylase and lipase levels. Thoracoabdominal computed tomography revealed massive disruption of the pancreatic head with pancreatic duct disruption and gas accumulation in the posterior part of the pancreas indicating localized duodenal perforation. Surgery was indicated and our surgical team chose to perform in a minimally invasive way with robotic assisted laparoscopic system based on the previous successful experience. A massive disruption of the pancreatic head (AAST-OIS grade V in pancreatic injury) and a laceration involving 30% of the circumference of the first part of the duodenum (AAST-OIS grade II in duodenal injury) without biliary system involvement were confirmed during surgery. A partial resection of the devitalized pancreatic head, primary suture of the duodenal laceration, and Roux-en-Y pancreaticojejunostomy with preservation of the pancreatic tail was performed in robotic-assisted laparoscopy. The patient resumed oral feeding on postoperative day 10 and was discharged 14 days postoperatively. At the 1-year follow-up, the patient demonstrated satisfactory recovery without any significant complications. Conclusion: For hemodynamically stable patients with high-grade pancreaticoduodenal injury, operative management is an appropriate therapeutic strategy. Application of robotic surgery may be a potentially optimal choice for primary repair in pediatric severe pancreaticoduodenal injury.