P3579 - Disconnected Pancreatic Duct Syndrome: A Rare Complication of Necrotizing Pancreatitis Requiring Endoscopic Transpapillary Stenting

Stephanie Ibarra Lepe, MD¹, Christin Wilkinson, MD², Abdulazeez Swaiti, MD², Jinye Liu, DO¹, Michelle Cooley, BS³, M Danial Ali Shah, MD⁴, Christina Santana, MD¹, Saeed Graham, MD², Catherine Gray, BS³, Matthew Tugman, BA³, Amy Chang, MD¹, Rahul Pamarthy, MD², Zarak Khan, MD⁵, Hassam Ali, MD², Karissa Lambert, MD⁵, Prashant Mudireddy, MD^5
1East Carolina University Medical Center, Greenville, NC; ²East Carolina University, Greenville, NC; ³East Carolina University Brody School of Medicine, Greenville, NC; ⁴King Edward Medical University, Lahore, Punjab, Pakistan; ⁵East Carolina Gastroenterology, Greenville, NC

Introduction: Disconnected pancreatic duct syndrome (DPDS) occurs when the pancreatic duct's integrity is compromised, often due to necrotizing pancreatitis. A study found evidence of DPDS in 74% of necrotizing pancreatitis cases. This disruption between distal viable pancreatic tissue and the rest of the gastrointestinal tract causes ongoing leakage of pancreatic fluid, which further damages adjacent tissues. Complications include pancreatic fistulae, pancreatic ascites, and chronic pancreatitis. Treatment for DPDS primarily involves surgery and endoscopy, which include resection and internal as well as endoscopic drainage.

Case Description/Methods: A 68-year-old patient with hypertension, type 2 diabetes, chronic kidney disease, and a history of cholecystectomy complicated by necrotizing pancreatitis and pseudocyst formation presented with persistent abdominal pain, nausea, and vomiting. Imaging showed a previous pseudocyst replacing most of the pancreatic parenchyma, a new pseudocyst, and acute pancreatitis. During EGD/EUS, the cysts were decreasing in size and not causing gastric outlet obstruction, negating the need for drainage. The patient's course was complicated by a pleural effusion with underlying empyema, likely from necrotizing pancreatitis. A repeat EGD with ERCP revealed a disconnected pancreatic duct, indicated by contrast extravasation in the pancreatic head and genu. A pigtail plastic stent was placed in the duct. Due to the patient’s overall condition, they were unsuitable for partial pancreatectomy. As the patient’s condition deteriorated, the family chose comfort measures and palliative care.

Discussion: DPDS is a rare and often overlooked complication of necrotizing pancreatitis. There are no standardized treatment guidelines, with options ranging from drainage procedures to surgical interventions. In clinical practice, endoscopic cannulation and stenting are particularly challenging, while surgical approaches are highly invasive. Treatment recurrence and failure rates are significant, estimated at 10-30%. This uncertainty frequently results in underdiagnosis, delayed management, and inadequate follow-up care.



Disclosures:


Stephanie Ibarra Lepe, MD¹, Christin Wilkinson, MD², Abdulazeez Swaiti, MD², Jinye Liu, DO¹, Michelle Cooley, BS³, M Danial Ali Shah, MD⁴, Christina Santana, MD¹, Saeed Graham, MD², Catherine Gray, BS³, Matthew Tugman, BA³, Amy Chang, MD¹, Rahul Pamarthy, MD², Zarak Khan, MD⁵, Hassam Ali, MD², Karissa Lambert, MD⁵, Prashant Mudireddy, MD⁵. P3579 - Disconnected Pancreatic Duct Syndrome: A Rare Complication of Necrotizing Pancreatitis Requiring Endoscopic Transpapillary Stenting, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.