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Pancreas and Superior Mesenteric Vein

A patient with penetrating trauma arrives alert, with a GCS of 15/15, blood pressure of 96/76 mmHg, and a heart rate of 94 bpm. He has signs of peritoneal irritation. E-FAST shows a left hemothorax and free fluid in the hepatorenal, splenorenal, and suprapubic windows.

The massive transfusion protocol is activated. At laparotomy there are 2,000 mL of hemoperitoneum, a zone I retroperitoneal hematoma, and injuries to the stomach, gallbladder, liver, transverse colon, pancreatic head, and superior mesenteric vein.

Bleeding from the mesenteric vein is controlled, and the patient remains stable. That is where the decision begins.

The question is not just: How do you repair each injury?

The question is: How much should you fix in this first operation?

Estimated duration: 90–120 minutes
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