Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases

Gastrointest Endosc. 2008 Jul;68(1):91-7. doi: 10.1016/j.gie.2007.11.041. Epub 2008 Apr 18.


Background: Information regarding the natural history, clinical characteristics, and outcomes of disconnected pancreatic duct syndrome (DPDS) is limited.

Objective: To describe clinical characteristics and outcomes of DPDS.

Design: A retrospective review of the Mayo Clinic endoscopy and hospital service database.

Setting: Tertiary-referral center.

Patients: We identified 31 DPDS cases from 1999 to 2006.

Interventions: Endoscopic drainage of pancreatic-fluid collections.

Main outcome measurements: The relationship between demographic and clinical data with endoscopic treatment and clinical outcomes in DPDS cases.

Results: The median patient age was 53 years (range 20-83 years); 48% were men. The most common etiology of acute pancreatitis (AP) was biliary (55%) followed by idiopathic (27%). The median interval between the diagnoses of AP and DPDS was 56 days (range 3-251 days); the median follow-up after the last ERCP or surgical procedure was 7 months (range 0-90 months). The DPDS location included the following: pancreas head 6%, neck 58%, body 26%, and tail 10%. Twenty-six patients had initial endoscopic treatment (19 had long-term improvement; 7 failed treatment and required surgery) and 5 underwent immediate surgery. Mortality was 0%; 26% developed chronic pancreatitis (CP) and 16% diabetes mellitus (DM); 10% resolved completely, 45% had smaller fluid collections, and 26% patients were lost to follow-up. No relationship between demographic and clinical data with endoscopic and clinical outcomes was found.

Conclusions: Endoscopic treatment temporarily improved DPDS, with a failure rate of 23%. Immediate surgery was not required in all cases. CP and/or pancreatic atrophy occurred relatively shortly after the DPDS diagnosis in 26% and DM in 16% of cases. DPDS did not lead to mortality. Early surgery may be considered after initially stabilizing the fluid collection with endoscopic therapy.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Cholangiopancreatography, Endoscopic Retrograde / methods
  • Cohort Studies
  • Diagnostic Imaging / methods*
  • Drainage / methods
  • Endoscopy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Laparotomy / methods
  • Male
  • Middle Aged
  • Pancreatic Ducts / abnormalities*
  • Pancreatic Ducts / surgery*
  • Pancreatic Fistula / etiology
  • Pancreatic Fistula / surgery
  • Pancreatic Pseudocyst / etiology
  • Pancreatic Pseudocyst / pathology
  • Pancreatic Pseudocyst / surgery
  • Pancreatitis / complications*
  • Pancreatitis / diagnosis*
  • Pancreatitis / mortality
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Survival Rate
  • Syndrome
  • Tomography, X-Ray Computed
  • Treatment Outcome