Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 199

Disconnected pancreatic duct syndrome is a clinical entity characterized by recurrent pancreatitis and persistent extraductal leakage of pancreatic secretions from a disconnected pancreatic tail as a result of complete transection of the pancreatic duct, usually occurring in the setting of a severe episode of acute pancreatitis [14]. The syndrome complicates nearly two‐thirds of pancreatic necrotic collections and one‐third of other pancreatic fluid collections. The diagnosis can be made with varying degrees of accuracy by secretin‐stimulated MRCP, ERCP, EUS, and contrast‐enhanced CT. Successful management requires effective drainage of the disconnected pancreatic segment. If transluminal stent‐assisted drainage of the pseudocyst was undertaken, the most common approach is to maintain the cystenterostomy patent by keeping the transluminal stents in place indefinitely. This is one of the most compelling arguments for recommending the use of plastic over metal stents for transluminal drainage of pancreatic pseudocysts. Transpapillary stent placement into the disconnected duct segment is technically challenging but is not impossible and certainly worth trying. EUS‐guided transluminal placement of a plastic stent into the disconnected duct segment has also been described. Ultimately, if all endoscopic endeavors prove unsuccessful, surgical resection of the disconnected pancreatic segment or even total pancreatectomy with islet cell autotransplantation may be the only therapeutic option.