S3255 Pancreatic Duct Stent Placement Following a Pancreatic Ductal Disruption Secondary to Chronic Pancreatitis: A Case Study

Introduction: Disconnected pancreatic duct syndrome (DPDS) refers to rupture or injury of the pancreatic duct, often resulting from severe or necrotizing acute pancreatitis, though it can also stem from blunt abdominal trauma, surgical complications, pancreatic malignancy, or chronic pancreatitis. It leads to disconnection of the main pancreatic duct from the duodenum or small intestine, impairing drainage of pancreatic juices and causing various complications. We present a comprehensive case of DPDS, explore its clinical significance, highlight diagnostic and treatment approaches used, and emphasize the need for further research to establish universally accepted guidelines. Case Description/Methods: A 57-year-old man with chronic pancreatitis and metabolic dysfunction-associated steatotic liver disease cirrhosis presented with dyspnea, lightheadedness, and abdominal distension. Paracentesis revealed ascitic fluid with high amylase, concerning for a pancreatic duct leak. Initial endoscopic retrograde cholangiopancreatography (ERCP) with pancreatogram failed; repeat ERCP 3 days later confirmed a leak. A pancreatic sphincterotomy was performed and a plastic stent placed in the ventral duct. Despite intervention, he had recurrent ascites requiring paracentesis, which later revealed Candida peritonitis and Streptococcal septicemia. Hepatic abscesses developed, necessitating interventional radiology (IR)-guided drain placement. Persistent abscesses prompted transfer to a tertiary center for potential further IR procedures. His course was further complicated by left pleural effusion and pneumothorax. Two ventral drains were placed and later removed following computed tomography-confirmed improvement. He was discharged on Augmentin and oral fluconazole to complete 4 weeks post-drain removal, totaling 8–10 weeks of antibiotic therapy. Discussion: Pancreatic ductal disruptions may result in leakage of pancreatic enzymes into the abdominal cavity, leading to complications such as recurrent (peri-)pancreatic fluid collections, pancreatic ascites, pleural effusions, persistent fistula, peritonitis, or abscesses, as seen in this case. The condition remains underrecognized, often delaying diagnosis. Imaging modalities include contrast-enhanced computed tomography, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography (ERCP). Prompt diagnosis is essential, with management options including percutaneous drainage, surgery, or endoscopic interventions to repair the duct or drain collections. This case illustrates the complexity and severity of DPDS and reinforces the urgent need for universally recognized guidelines to aid in timely diagnosis and effective management.