A 35-year-old woman with a history of chronic pancreatitis secondary to alcohol use presented with diffuse abdominal discomfort and ascites. The ascitic fluid had an amylase level of 3000 IU. The patient was placed NPO and received total parenteral nutrition (TPN) for 8 weeks without any improvement in her symptoms.
Eight weeks following presentation, she underwent endoscopic retrograde cholangiopancreatography, which revealed a disruption of the main pancreatic duct, with extravasation of contrast into the peritoneal space (Figure 1).
Figure 1. Pancreatogram demonstrating pancreas divisum with a tortuous, ectatic dorsal PD and extravasation of contrast into the peritoneum (arrows) at the level of the mid-body. Pancreatic calcifications are present. Cholangiogram is normal.
Ductal ectasia and pancreas divisum were also noted. A 7 French, 7-cm stent was placed over a guidewire into the dorsal pancreatic duct (PD). The stent was positioned to bridge the disruption (Figure 2).
The stent was left in situ for 5 weeks, during which time the ascites completely resolved. Pancreatography at the time of stent removal demonstrated resolution of the disruption (Figure 3).
Figure 3. Pancreatogram following stent removal, 5 weeks later, demonstrating an irregular main duct and resolution of the PD disruption.
The patient did well over follow-up of several years, abstaining from alcohol and adhering to a low-fat diet. She has had no additional evidence of pancreatic ascites clinically or by imaging, and her pancreatitis flares have become less frequent.
Medscape Gastroenterology. 2001;3(2) © 2001 Medscape
Cite this: Pancreatic Duct Disruption Treated With Endoscopic Transpapillary Pancreatic Duct Stent Placement - Medscape - Nov 13, 2001.