Roux-en-Y fistulojejunostomy as a salvage procedure for displaced pancreatic stent in disconnected pancreatic duct syndrome with refractory external pancreatic fistula

Post-traumatic disconnected pancreatic duct syndrome (DPDS) can present as persistent external pancreatic fistula following percutaneous drainage (PCD) of pancreatic collection. Management of these cases can be difficult and involves a multidisciplinary approach. Here, we present a case of a 16-year-old boy who presented with persisted pancreatic fistula following initial management including PCD of peripancreatic collection following polytrauma 3 months prior. Magnetic resonance imaging showed a disconnected pancreatic duct. Intraoperatively, there was a disconnected and viable distal pancreas with a defect cavity measuring 2 × 2 cm at the neck of the pancreas. The wall of the cavity was anastomosed with a Roux limb of the jejunum (cavitojejunostomy). Post-operative recovery was uneventful and the patient remains asymptomatic at 2 months of follow-up. Cavitojejunostomy is a feasible and safe surgical option in DPDS with a well-formed cavity. This avoids dissection in difficult anatomical planes and preserves pancreatic parenchyma.

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Impact of a 7.5-Fr Pancreatic Stent for Preventing Pancreatic Fistula after Pancreaticoduodenectomy

Digestive Surgery ◽

10.1159/000520462 ◽

2021 ◽

Vol 38 (5-6) ◽

pp. 361-367

Author(s):

Tomohiro Iguchi ◽

Takashi Motomura ◽

Hideaki Uchiyama ◽

Norifumi Iseda ◽

Rintaro Yoshida ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Postoperative Pancreatic Fistula ◽

Pancreatic Stent ◽

Factors Associated ◽

Soft Pancreas ◽

Pancreatic Duct Stent ◽

Pancreatic Texture ◽

Male Sex

Introduction: Pancreatic duct stents are widely used to reduce the incidence of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD); however, small stents may cause adverse effects, such as occlusion. Recently, we have tried placing a 7.5-Fr pancreatic duct stent to achieve more effective exocrine output from the pancreas; however, the association between pancreatic duct stent size and POPF remains unknown. Methods: Sixty-five patients with soft pancreatic texture who underwent PD were retrospectively analyzed. After dividing the pancreas, a pancreatic duct stent (stent size 4.0 in 29 patients, 5.0 in 18, and 7.5 Fr in 18) was placed in the main pancreatic duct. Results: Twenty-five of 65 patients with soft pancreatic texture (38.5%) developed POPF. POPF became less frequent as the pancreatic duct stent size increased (p = 0.003). The factors associated with POPF development were a 7.5-Fr pancreatic duct stent (p = 0.005), 5.0-Fr pancreatic duct stent (p = 0.031), and male sex (p = 0.008). Pancreatic duct stent size and pancreatic duct diameter did not differ between the POPF and non-POPF groups. Discussion/Conclusions: In patients with a soft pancreas, the placement of a 7.5-Fr pancreatic duct stent may reduce the incidence of POPF.

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Roux-en-Y drainage of a pancreatic fistula for disconnected pancreatic duct syndrome after acute necrotizing pancreatitis

HPB ◽

10.1111/j.1477-2574.2011.00397.x ◽

2012 ◽

Vol 14 (1) ◽

pp. 26-31 ◽

Cited By ~ 21

Author(s):

Erik G. Pearson ◽

Courtney L. Scaife ◽

Sean J. Mulvihill ◽

Robert E. Glasgow

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Necrotizing Pancreatitis ◽

Acute Necrotizing Pancreatitis ◽

Acute Necrotizing ◽

Duct Syndrome

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Intentional endoscopic nasopancreatic drainage to a pancreatic fistula in the treatment of disconnected pancreatic duct syndrome

Endoscopy ◽

10.1055/a-1264-6949 ◽

2020 ◽

Author(s):

Yasuki Hori ◽

Kazuki Hayashi ◽

Itaru Naitoh ◽

Michihiro Yoshida ◽

Hiromi Kataoka

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Endoscopic Nasopancreatic Drainage ◽

Nasopancreatic Drainage ◽

Duct Syndrome

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Natural course of low output external pancreatic fistula in patients with disconnected pancreatic duct syndrome following acute necrotising pancreatitis

Pancreatology ◽

10.1016/j.pan.2019.12.011 ◽

2020 ◽

Vol 20 (2) ◽

pp. 177-181 ◽

Cited By ~ 2

Author(s):

Surinder Singh Rana ◽

Ravi Sharma ◽

Mandeep Kang ◽

Rajesh Gupta

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Natural Course ◽

Necrotising Pancreatitis ◽

Acute Necrotising Pancreatitis ◽

Acute Necrotising ◽

Duct Syndrome

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603 – Natural History of Low Output External Pancreatic Fistula in Patients with Disconnected Pancreatic Duct Syndrome Following Acute Necrotising Pancreatitis

Gastroenterology ◽

10.1016/s0016-5085(19)37094-5 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-121

Author(s):

Surinder S. Rana ◽

Ravi K. Sharma ◽

Mandeep Kang ◽

Rajesh Gupta

Keyword(s):

Natural History ◽

Pancreatic Fistula ◽

Pancreatic Duct ◽

Necrotising Pancreatitis ◽

Acute Necrotising Pancreatitis ◽

History Of ◽

Acute Necrotising ◽

Duct Syndrome

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DISCONNECTED PANCREATIC DUCT SYNDROME (DPDS): ENDOSCOPIC REPAIR BY MEANS OF STAGED EUS-GUIDED PANCREATICO-GASTROSTOMY (EUS-PG) COMBINED WITH ERCP

10.1055/s-0040-1704253 ◽

2020 ◽

Author(s):

R Sánchez-Ocaña ◽

G Salazar ◽

C Chavarria Herbozo ◽

C Chavarría ◽

J Garcia Alonso ◽

...

Keyword(s):

Pancreatic Duct ◽

Endoscopic Repair ◽

Duct Syndrome

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The Disconnected Main Pancreatic Duct Syndrome

Clinical Pancreatology for Practising Gastroenterologists and Surgeons ◽

10.1002/9781119570097.ch18 ◽

2021 ◽

pp. 126-131

Author(s):

Mario Peláez‐Luna ◽

Andrea Soriano‐Ríos ◽

Luis Uscanga‐Dominguez

Keyword(s):

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Duct Syndrome

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Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis

BMC Gastroenterology ◽

10.1186/s12876-021-01663-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eric Chong ◽

Chathura Bathiya Ratnayake ◽

Samantha Saikia ◽

Manu Nayar ◽

Kofi Oppong ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Duct ◽

Meta Analysis ◽

Fluid Collection ◽

Significant Heterogeneity ◽

Success Rates ◽

Surgical Interventions ◽

Transmural Drainage ◽

Transpapillary Drainage ◽

Duct Syndrome

Abstract Background Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS. Methods The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites. Results Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0–95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7–77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6–90.5) and 87.4% (95%-CI 81.2–91.8), respectively (P = 0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

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