With regards to open surgery for carcinoma of the head of the pancreas, list the anastomoses formed during a Whipples procedure. (30% marks)
List the complications of this procedure that are of relevance to its ICU management. (70% marks)
(A list of anastomoses was acceptable; the diagram is provided for clarity).
List complications specific to this procedure of relevance to the Intensive Care management of patients who have had this procedure. (7 marks)
Specific early surgical complications (4 marks) Primary haemorrhage
Pancreatic fistula Pancreatitis
GI anastomotic failure Portal or SMA thrombosis Diabetes Mellitus
Gastric outlet obstruction Late complications
Anastomotic stricture Delayed gastric emptying Pancreatic fistula
Malabsorption and electrolyte abnormalities secondary to the above
There was poor knowledge of the anatomy of a procedure that is commonly encountered in intensive care.
The sites of anastomosis:
This image is from thefreedictionary.com.
As one might imagine of a 6-8 hour procedure which ends with three anastomoses in the abdomen, "the complications of this procedure that are of relevance to its ICU management" are numerous, and making a coherent answer to this sort of question really relies on the candidate's abilities to categorise them quickly.
Intra-abdominal collections (12.2%)
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