Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2019; 7(9): 1053-1059
Published online May 6, 2019. doi: 10.12998/wjcc.v7.i9.1053
Management of the late effects of disconnected pancreatic duct syndrome: A case report
Reiko Yamada, Yuhei Umeda, Yasunori Shiono, Hiroaki Okuse, Naoki Kuroda, Junya Tsuboi, Hiroyuki Inoue, Yasuhiko Hamada, Kyosuke Tanaka, Noriyuki Horiki, Yoshiyuki Takei
Reiko Yamada, Yuhei Umeda, Yasunori Shiono, Hiroaki Okuse, Naoki Kuroda, Hiroyuki Inoue, Yoshiyuki Takei, Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
Junya Tsuboi, Yasuhiko Hamada, Kyosuke Tanaka, Noriyuki Horiki, Department of Endoscopy, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
Author contributions: Yamada R contributed to the conception of the study, drafting of the article, critical revision of the article for important intellectual content, and final approval of the article; Tanaka K contributed to the critical revision of the article for important intellectual content, and final approval of the article; Umeda Y, Shiono Y, Okuse H, Kuroda N, Tsuboi J, Inoue H, Hamada Y, Horiki N and Takei Y contributed to the technical and material support and final approval of the article.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Reiko Yamada, MD, PhD, Assistant Professor, Doctor, Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. reiko-t@clin.medic.mie-u.ac.jp
Telephone: +81-59-2315017 Fax: +81-59-2315269
Received: January 18, 2019
Peer-review started: January 18, 2019
First decision: January 30, 2019
Revised: March 6, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: May 6, 2019
Processing time: 109 Days and 5.7 Hours
Abstract
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.

Keywords: Case report; Endoscopy; Necrosis; Pancreas; Walled-off necrosis; Disconnected pancreatic duct syndrome

Core tip: There have been a few reports about the late effects of disconnected pancreatic duct syndrome. 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. Endoscopic transpapillary drainage was attempted first but failed. Thereafter, endoscopic ultrasound-guided drainage was performed. Subsequently, pancreatic inflammation resolved, and abdominal aortic stenting for the aneurysm was performed successfully. The patient has been infection free for more than 2 years post-procedure. This case highlights the importance of continued follow-up of patients for recurrence after the treatment of WON with pancreatic transection.