BACKGROUND There have been few reports about the late effects of disconnected pancreatic duct syndrome(DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurrenc...BACKGROUND There have been few reports about the late effects of disconnected pancreatic duct syndrome(DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurrence to occur more than 5 years later.Herein, we describe a case of recurrence in an 81-year-old man after the treatment of walled-off necrosis(WON) with pancreatic transection 7 years ago.CASE SUMMARY An 81-year-old man visited our hospital with chief complaints of fever and abdominal pain 7 years after the onset of WON due to severe necrotic pancreatitis. His medical history included an abdominal aortic aneurysm(AAA),hypertension, dyslipidemia, and chronic kidney disease. Computed tomography(CT) scan showed that the pancreatic fluid collection(PFC) had spread to the aorta with inflammation surrounding it, and CT findings suggested that bleeding occurred from the vasodilation due to splenic vein occlusion. First, we attempted to perform transpapillary drainage because of venous dilation around the residual stomach and the PFC. However, pancreatic duct drainage failed because of complete main pancreatic duct disruption. Second, we performed endoscopic ultrasound-guided drainage. After transmural drainage, the inflammation improved and stenting for the AAA was performed successfully. The inflammation was resolved, and he has been free from infection for more than 2 years after the procedure.CONCLUSION This case highlights the importance of continued follow-up of patients for recurrence after the treatment of WON with pancreatic transection.展开更多
Here we report a patient diagnosed with small cell lung cancer after first presenting with parathyroid hormonerelated peptide-induced hypercalcemic pancreatitis and developed walled-off necrosis that resulted in disru...Here we report a patient diagnosed with small cell lung cancer after first presenting with parathyroid hormonerelated peptide-induced hypercalcemic pancreatitis and developed walled-off necrosis that resulted in disruption of the main pancreatic duct.Disconnected duct syndrome (DDS) is a rare syndrome that occurs when the main pancreatic duct exocrine flow is disrupted resulting in leakage of pancreatic enzymes and further inflammatory sequela.To date,no prior reports have described DDS occurring with paraneoplastic reactions.Diagnostic imaging techniques and therapeutic interventions are reviewed to provide insight into current approaches to DDS.展开更多
BACKGROUND The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases.The basis of interventional treatment in these cases is anatomical transpapillary access of the main p...BACKGROUND The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases.The basis of interventional treatment in these cases is anatomical transpapillary access of the main pancreatic duct during endoscopic retrograde cholangiopancreatography(ERCP),which ensures the physiological outflow of pancreatic juice into the lumen of the digestive tract.However,in some patients,anatomical changes prevent transpapillary drainage of the main pancreatic duct.Surgery is the treatment of choice in such cases.AIM To evaluate the effectiveness and safety of endoscopic pancreaticogastrostomy under endoscopic ultrasound(EUS)guidance.METHODS Retrospective analysis of treatment outcomes of all patients with acute or chronic pancreatitis who underwent endoscopic pancreatogastric anastomosis under EUS guidance in 2018-2023 at the Department of General,Gastroenterological and Oncological Surgery,Ludwik Rydygier Collegium Medicum in Bydgoszcz,Nicolaus Copernicus University in Toruń,Poland.RESULTS In 9 patients[7 men,2 women;mean age 53.45(36-66)years],endoscopic pancreatogastric anastomosis under EUS guidance was performed because of the lack of transpapillary access during ERCP.Narrowing of the main pancreatic duct at the head of the pancreas was observed in 4/9 patients(44.44%).Pancreatic fragmentation(disconnected pancreatic duct syndrome)was diagnosed in 3/9 patients(33.33%).In 2/9 patients(22.22%),narrowing of the pancreatoenteric anastomosis was observed after pancreaticoduodenectomy.Technical success of endoscopic pancreaticogastrostomy was observed in 8/9 patients(88.89%).Endotherapeutic complications were observed in 2/9 patients(22.22%).Clinical success was achieved in 8/9 patients(88.89%).The mean follow-up period was 451(42-988)d.Long-term success of endoscopic pancreatogastric anastomosis was achieved in 7/9 patients(77.78%).CONCLUSION Endoscopic pancreaticogastrostomy under EUS guidance is an effective and safe treatment method,especially in the absence of transpapillary access to the main pancreatic duct.展开更多
文摘BACKGROUND There have been few reports about the late effects of disconnected pancreatic duct syndrome(DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurrence to occur more than 5 years later.Herein, we describe a case of recurrence in an 81-year-old man after the treatment of walled-off necrosis(WON) with pancreatic transection 7 years ago.CASE SUMMARY An 81-year-old man visited our hospital with chief complaints of fever and abdominal pain 7 years after the onset of WON due to severe necrotic pancreatitis. His medical history included an abdominal aortic aneurysm(AAA),hypertension, dyslipidemia, and chronic kidney disease. Computed tomography(CT) scan showed that the pancreatic fluid collection(PFC) had spread to the aorta with inflammation surrounding it, and CT findings suggested that bleeding occurred from the vasodilation due to splenic vein occlusion. First, we attempted to perform transpapillary drainage because of venous dilation around the residual stomach and the PFC. However, pancreatic duct drainage failed because of complete main pancreatic duct disruption. Second, we performed endoscopic ultrasound-guided drainage. After transmural drainage, the inflammation improved and stenting for the AAA was performed successfully. The inflammation was resolved, and he has been free from infection for more than 2 years after the procedure.CONCLUSION This case highlights the importance of continued follow-up of patients for recurrence after the treatment of WON with pancreatic transection.
文摘Here we report a patient diagnosed with small cell lung cancer after first presenting with parathyroid hormonerelated peptide-induced hypercalcemic pancreatitis and developed walled-off necrosis that resulted in disruption of the main pancreatic duct.Disconnected duct syndrome (DDS) is a rare syndrome that occurs when the main pancreatic duct exocrine flow is disrupted resulting in leakage of pancreatic enzymes and further inflammatory sequela.To date,no prior reports have described DDS occurring with paraneoplastic reactions.Diagnostic imaging techniques and therapeutic interventions are reviewed to provide insight into current approaches to DDS.
基金The study was approved by the ethics committee of Collegium Medicum of Nicolaus Copernicus University(Toruń,Poland),No.KB 379/2023。
文摘BACKGROUND The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases.The basis of interventional treatment in these cases is anatomical transpapillary access of the main pancreatic duct during endoscopic retrograde cholangiopancreatography(ERCP),which ensures the physiological outflow of pancreatic juice into the lumen of the digestive tract.However,in some patients,anatomical changes prevent transpapillary drainage of the main pancreatic duct.Surgery is the treatment of choice in such cases.AIM To evaluate the effectiveness and safety of endoscopic pancreaticogastrostomy under endoscopic ultrasound(EUS)guidance.METHODS Retrospective analysis of treatment outcomes of all patients with acute or chronic pancreatitis who underwent endoscopic pancreatogastric anastomosis under EUS guidance in 2018-2023 at the Department of General,Gastroenterological and Oncological Surgery,Ludwik Rydygier Collegium Medicum in Bydgoszcz,Nicolaus Copernicus University in Toruń,Poland.RESULTS In 9 patients[7 men,2 women;mean age 53.45(36-66)years],endoscopic pancreatogastric anastomosis under EUS guidance was performed because of the lack of transpapillary access during ERCP.Narrowing of the main pancreatic duct at the head of the pancreas was observed in 4/9 patients(44.44%).Pancreatic fragmentation(disconnected pancreatic duct syndrome)was diagnosed in 3/9 patients(33.33%).In 2/9 patients(22.22%),narrowing of the pancreatoenteric anastomosis was observed after pancreaticoduodenectomy.Technical success of endoscopic pancreaticogastrostomy was observed in 8/9 patients(88.89%).Endotherapeutic complications were observed in 2/9 patients(22.22%).Clinical success was achieved in 8/9 patients(88.89%).The mean follow-up period was 451(42-988)d.Long-term success of endoscopic pancreatogastric anastomosis was achieved in 7/9 patients(77.78%).CONCLUSION Endoscopic pancreaticogastrostomy under EUS guidance is an effective and safe treatment method,especially in the absence of transpapillary access to the main pancreatic duct.
