Disconnected Pancreatic Duct Syndrome in Necrotizing Pancreatitis Managed by Open Surgery: A Case Report

Case Report

Abstract

A 38 years old man was admitted with spontaneous rupture of walled of Necrosis of the pancreas. He had an attack of with acute pancreatitis 4 months ago for which he was hospitalized and treated conservatively. USG and MRCP shows a cavity with necrotic collection in the head area of the pancreas. On emergency laparotomy there was about 500 ml of free fluid in the peritoneal cavity. A cavity was noted in the head area which ruptured to the infracolic compartment through the transverse mesocolon. Pancreatic necrotic material and pus was drained from the cavity. After lavage an external tube drain was placed. Patient stayed in the hospital for 3 weeks on antibiotic, parenteral nutrition and Octerotide and blood transfusion. 150 ml of clear pancreatic secretion continued to drain via the abdominal drain. It was diagnosed as a case of external pancreatic fistula due to disconnected pancreatic duct syndrome (DPDS). After 2 months Roux-Y fistula-jejunostomy was done to close the pancreatic fistula and allow physiological drainage of the pancreatic juice to the jejunum. Patient recovered fully.