David Truscello, DO, Nishi Pandey, DO, Maulik Shah, DO, Michael Itidiare, DO, BS, Drew J. Chiesa, DO, Justin DeRosa, DO
Rowan University School of Osteopathic Medicine, Stratford, NJ
What follows is a case study of a patient with a pancreatic pseudocyst who developed a complication of Disconnected Pancreatic Duct Syndrome (DPDS). Pseudocysts are a collection of fluid and tissue that forms as result of trauma or repeated spells of pancreatitis. A rare complication of these cysts is disruption of the pancreatic duct termed (DPDS). This case report will discuss the diagnosis and management DPDS along with highlighting the use of endoscopic stenting for the management.
The patient is a 49 year old male who presented to the hospital with sudden onset epigastric pain and distention. His past medical history includes chronic pancreatitis, and alcoholic cirrhosis with ascites, requiring large volume paracenteses. On admission, the patient’s physical exam was remarkable for diffuse abdominal tenderness and ascites. Labwork was significant for a lipase of 329 U/L, albumin of 2.5 U/L, and a hemoglobin of 8.4 g/dL. Given the patient's abdominal tenderness, a paracentesis was performed with a resulting cell count concerning for Spontaneous Bacterial Peritonitis. A week later, patient had marked improvement in his abdominal exam. However, a CBC drawn on day 7 revealed a hemoglobin of 6.9 g/dL. A CT scan was ordered revealing an 8 cm inflammatory mass/pseudocyst in the head of the pancreas compressing the main portal vein. Another paracentesis was performed which showed high amylase consistent with a pancreatic source. Given these findings, GI performed a magnetic resonance cholangiopancreatography which showed pancreatic duct disconnection complicated by a large 6.4 x 5.5 cm cystic collection at the pancreatic head. An ERCP was performed with the implementation of a lumen apposing stent.
DPDS is usually diagnosed with contrast enhanced CT which shows an absence of the pancreatic neck, body or tail. ERCP is usually able to show cut-off of the pancreatic duct or extravasation of contrast. ERCP with stenting is one minimally invasive intervention that has shown to reduce the recurrence rate of fluid collection. There are two challenges that are commonly encountered: high rates of stent migration and inability to pass a stent between the two disconnected ends of the duct. Due to the fact that there is still a lot that is not known about this disease state the consensus on optimal management remains to be determined. DPDS is a disease state that can be difficult to manage which is why early identification is the mainstay of successful treatment.
Citation: David Truscello, DO, Nishi Pandey, DO, Maulik Shah, DO, Michael Itidiare, DO, BS, Drew J. Chiesa, DO, Justin DeRosa, DO. P0086 - DISCONNECTED PANCREATIC DUCT SYNDROME A RARE COMPLICATION. Program No. P0086. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.