Disconnected Pancreatic Duct Syndrome: A Rare Complication of Acute Pancreatitis

TL;DR

This paper presents a rare case of disconnected pancreatic duct syndrome following acute pancreatitis, highlighting the diagnostic and treatment challenges involved.

Contribution

The paper contributes a detailed clinical case report of DPDS, emphasizing its management complexities and the need for a multidisciplinary approach.

Findings

DPDS can lead to persistent pancreatic drainage and recurrent fluid collections after severe pancreatitis.

Endoscopic transgastric drainage successfully resolved symptoms in this case.

A multidisciplinary approach is essential for optimal management of DPDS.

Abstract

Disconnected pancreatic duct syndrome (DPDS) is a rare but serious complication of necrotizing pancreatitis, characterized by disruption of the main pancreatic duct, which separates a viable upstream pancreatic segment from the downstream ductal system, resulting in persistent pancreatic secretions and recurrent fluid collections. We report a clinical case of acute biliary pancreatitis complicated by DPDS to highlight diagnostic and therapeutic challenges. The patient initially developed necrotizing changes with peripancreatic collections requiring surgical intervention for hemorrhagic control and retroperitoneal drainage, followed by management of postoperative infectious complications and definitive treatment of the biliary etiology. Persistent external pancreatic drainage and intolerance to oral feeding prompted further evaluation, and magnetic resonance cholangiopancreatography demonstrated a complete ductal discontinuity consistent with DPDS. Despite initial clinical improvement, the patient developed recurrent symptoms related to a new intra-abdominal fluid collection, causing gastrointestinal compression. Endoscopic transgastric drainage was successfully performed, leading to the resolution of symptoms and clinical stabilization.

This case illustrates the complex and protracted course that DPDS may entail, as well as the importance of maintaining a high index of suspicion in patients with persistent or recurrent pancreatic collections after severe pancreatitis. Timely imaging, accurate diagnosis, and a multidisciplinary approach integrating surgical, radiologic, and endoscopic expertise are crucial to optimize management and improve outcomes in this challenging condition.

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