A young patient presents with a massive injury to proximal duodenum, head of pancreas and distal common bile duct. The procedure of choice in this patient should be
**Core Concept**
The patient's condition, which involves a massive injury to the proximal duodenum, head of pancreas, and distal common bile duct, is a classic example of a severe pancreaticoduodenal injury. This type of injury requires a surgical intervention that addresses the damage to these critical structures.
**Why the Correct Answer is Right**
The procedure of choice in this scenario is a **Whipple procedure**, also known as a pancreaticoduodenectomy. This surgical operation involves the removal of the head of the pancreas, the duodenum, and a portion of the bile duct, along with the reconnection of the remaining pancreatic and bile ducts to the small intestine. The Whipple procedure is a complex and technically challenging surgery that requires a high level of expertise.
**Option A:** **Duodenojejunostomy** is a procedure that involves creating a connection between the duodenum and the jejunum, but it does not address the damage to the head of the pancreas and the distal common bile duct. Therefore, it is not the procedure of choice for this patient.
**Option B:** **Pancreaticoduodenectomy with preservation of the pancreatic head** is not a standard surgical procedure, and it would not be suitable for a patient with a massive injury to the head of the pancreas.
**Option D:** **Distal pancreatectomy** involves the removal of the tail of the pancreas, which is not sufficient to address the damage to the head of the pancreas and the proximal duodenum.
**Clinical Pearl / High-Yield Fact**
The Whipple procedure is a complex surgery that carries a high risk of complications, including pancreatic fistula, bleeding, and infection. It is essential to carefully evaluate the patient's condition and consider the risks and benefits of the surgery before proceeding.
**Correct Answer:** C. Pancreaticoduodenectomy.