A case of a gunshot wound to the head of the pancreas and superior mesenter
ic vein requiring pancreaticoduodenectomy ;is discussed. Managing such an i
njury is challenging, first because of the ongoing hemorrhage and second be
cause of the technical difficulty in working with a normal pancreas and bil
e duct. Ln the case presented herein, enteric reconstruction was performed
72 hours after the initial surgery. A delay in reconstruction resulted in t
issue changes that Facilitated enteric reconstruction. A two-stage pancreat
icoduodenectomy may be considered if the surgeon is faced with an unstable
patient.