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. 2022 Nov 11:11:19-25.
doi: 10.1016/j.sopen.2022.10.009. eCollection 2023 Jan.

Disconnected pancreatic duct syndrome in patients with necrotizing pancreatitis

Petr Vanek  1 , Ondrej Urban  1 , Guru Trikudanathan  2 , Martin L Freeman  2
Affiliations

Disconnected pancreatic duct syndrome in patients with necrotizing pancreatitis

Petr Vanek et al. Surg Open Sci. .

Abstract

In a subset of patients with acute necrotizing pancreatitis, segmental necrosis affecting the main pancreatic duct may result in a discontinuity between the left-sided pancreas and the duodenum. Such an interruption in the setting of a viable upstream portion of the gland can give rise to the disconnected pancreatic duct syndrome (DPDS). By maintaining its secretory function, the disconnected segment may lead to persistent external pancreatic fistulae, recurrent pancreatic fluid collections, and/or obstructive recurrent acute or chronic pancreatitis of the isolated parenchyma. There are currently no universally accepted guidelines for the diagnosis or treatment of DPDS, and because the condition is underrecognized, the diagnosis is often delayed. DPDS is associated with a prolonged disease course and poses a burden on patients' quality of life as well as high health care resource utilization. The aim of our review is to summarize current knowledge, discuss diagnostic approaches, outline management options, and raise awareness of this challenging complication of necrotizing pancreatitis.

Keywords: Acute necrotizing pancreatitis; Disconnected pancreatic duct syndrome; Pancreatic duct disconnection; Pancreatic duct disruption; Pancreatic fistula; Pancreatic pseudocyst; Walled-off necrosis.

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Conflict of interest statement

All authors declare no conflicts of interest in relation to this article.

Figures

Fig. 1
Fig. 1
Acute necrotizing pancreatitis within the body of the pancreas encompassing the main pancreatic duct – an illustration. Template courtesy of Dr. Rajeev Attam, Kaiser Permanente, CA, USA.
Fig. 2
Fig. 2
Anatomical situation of a disconnected pancreatic duct following acute necrotizing pancreatitis – an illustration. Template courtesy of Dr. Rajeev Attam, Kaiser Permanente, CA, USA.
Fig. 3
Fig. 3
Anatomical and pathophysiological situation of the disconnected pancreatic duct syndrome – an illustration. Template courtesy of Dr. Rajeev Attam, Kaiser Permanente, CA, USA.
Fig. 4
Fig. 4
CECT depicting disconnected pancreas (circled) in the setting of walled-off necrosis (WON). CECT – contrast-enhanced computed tomography.
Fig. 5
Fig. 5
CECT depicting acute necrotic collection (ANC) at the junction of the pancreatic head/body representing a likely site of an interrupted MPD with a viable upstream segment (arrows). CECT – contrast-enhanced computed tomography, MPD – main pancreatic duct.
Fig. 6
Fig. 6
Isolated distal pancreatic segment with duct dilatation (circled) in the setting of pancreatic body necrosis in a patient following endoscopic transmural drainage of WON; two indwelling DPSs in place (arrows). Courtesy of Dr. Rajeev Attam, Kaiser Permanente, CA, USA. WON – walled-off necrosis, DPS – double pigtail stent.
Fig. 7
Fig. 7
Pancreatogram using sMRCP in a patient with DPDS diagnosed 5.5 years after index NP; isolated upstream pancreatic duct is circled. sMRCP – secretin-enhanced magnetic resonance cholangiopancreatography, DPDS – disconnected pancreatic duct syndrome, NP – necrotizing pancreatitis.
Fig. 8
Fig. 8
Endoscopic pancreaticogastrostomy as treatment for the disconnected pancreatic duct syndrome – an illustration. Template courtesy of Dr. Rajeev Attam, Kaiser Permanente, CA, USA.
See this image and copyright information in PMC

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