Introduction: Firearm violence accounts for more than 70% of homicides in Brazil and represents a significant cause of years of potential life lost. Gunshot wounds to pancreaticoduodenal organs are rare (representing only 0.3% of abdominal traumas) and carry high morbidity and mortality rates. The literature recommends conservative treatment or primary repair for AAST grade 1–2 injuries, while more severe injuries (AAST 3–5) may require damage control strategies and, in selected cases, extensive resections such as pancreaticoduodenectomy (Whipple procedure). Case Report: A 23-year-old male, victim of a thoracoabdominal gunshot wound, arrived at the emergency department with a Glasgow score of 5 and hemodynamic instability. He was intubated and underwent an emergency midline laparotomy. The identified injuries were: 1. Transverse colon > 50% of the circumference (AAST grade 3); 2. Transfixing stomach injury (AAST grade 3); 3. Duodenum, D2 portion (AAST grade 3); 4. Head of the pancreas with distal bile duct rupture (AAST grade 5). A damage control approach was chosen: primary suture of the colon, partial gastrectomy, and resection of the duodenum and pancreatic head, followed by vacuum-assisted closure (peritoneostomy). After 48 hours in the ICU, a second-look surgery was performed for definitive reconstruction: Roux-en-Y gastroenteroanastomosis, duct-to-mucosa pancreaticojejunostomy, and bilioenteric anastomosis. During the postoperative period, transverse colostomy dehiscence and a biliopancreatic mucous fistula occurred, which were managed with a definitive colostomy, local drainage, and prolonged vacuum-assisted closure. The patient was discharged after 87 days, without a stoma, ambulating, and on oral intake. Approximately 14 months after the initial trauma, the patient underwent intestinal reconstruction and incisional hernioplasty, with no further complications following the procedure. Discussion: High-grade pancreaticoduodenal traumas (AAST 4–5) present an in-hospital mortality rate exceeding 12%, primarily due to hemorrhage and injury to adjacent organs. The protocol for unstable patients indicates immediate laparotomy. For AAST 3–4 injuries, primary repair or external drainage associated with damage control is usually sufficient; however, AAST 5 injuries (involving the pancreatic duct or Ampulla of Vater) indicate resection. Pancreaticoduodenectomy in trauma, although controversial, is indicated in < 1% of cases when primary repair of the pancreatic and duodenal ducts is impossible. Studies report mortality rates of up to 34% in this context, highlighting the importance of staged reconstruction after hemodynamic stabilization and the use of negative pressure wound therapy to reduce compartment syndrome. Early enteral nutrition and multidisciplinary management are crucial to minimizing late complications, such as fistulas and dehiscence.