Disconnected Pancreatic Duct Syndrome: Management Outcome Analysis and Literature Review

Background and objectives: Disconnected pancreatic duct syndrome is a known complication post necrosectomy and is easily missed .There is little literature available to guide its management. This study aimed to investigate the demographics, etiology, clinical features, radiological features, and outcome of endoscopic and surgical management of patients with disconnected duct syndrome following surgery for severe acute pancreatitis and to compare it with management outcomes across the globe. Method: A retrospective analysis of patients diagnosed with disconnected duct syndrome following necrosectomy between 2008 and 2013 was conducted. Results: A total of 18 patients with DPDS were identified. The median patient age of presentation was 27 years, and 94% of the patients were men. The most common etiology was acute necrotizing pancreatitis. The median interval between diagnosis of acute necrotizing pancreatitis and surgery was two months (range 0 - 7 months). About 45% of patients with severe acute pancreatitis developed DPDS. Nine patients had an initial failed endoscopic intervention and required distal pancreatectomy. Only one patient underwent a successful endoscopy. The remaining 17 patients underwent surgery. The mortality after surgery was 0%, and 30% of the patients developed diabetes mellitus. Discussion: Disconnected pancreatic duct syndrome should be considered if external pancreatic fistula persists beyond two months. Endoscopic treatment has a high failure rate, and surgery is almost always required to treat disconnected pancreatic duct syndrome.