Disconnection of the pancreatic duct: An important but overlooked complication of severe acute pancreatitis

Kumaresan Sandrasegaran, Mark Tann, S. Gregory Jennings, Dean D. Maglinte, Sanjit D. Peter, Stuart Sherman, Thomas J. Howard

Research output: Contribution to journalReview article

57 Scopus citations

Abstract

In patients with severe acute pancreatitis, the percentage of necrosis of pancreatic glandular parenchyma is an important predictor of prognosis. However, little attention has been paid to necrosis of ductal epithelium, which may result in disconnection of the main pancreatic duct. In pancreatic duct disconnection, a viable segment of the pancreatic body or tail is isolated from the gastrointestinal tract; the result is a persistent end fistula, that is, an uncontrolled leak of pancreatic secretions into peripancreatic spaces without communication to the gastrointestinal tract. The authors present their experience with clinical and radiologic follow-up of 85 patients with necrotic pancreatitis who either did (n = 46) or did not (n = 39) have pancreatic duct disconnection at surgery. Confident preoperative diagnosis of a disconnected duct requires both imaging tests (computed tomography or magnetic resonance imaging) and pancreatography. However, not all peripancreatic collections signify ductal disconnection, and imaging has poor accuracy in differentiation between pancreatic and peripancreatic necrosis. Early recognition of disconnected pancreatic duct obviates unnecessary and potentially harmful drainage procedures.

Original languageEnglish (US)
Pages (from-to)1389-1400
Number of pages12
JournalRadiographics
Volume27
Issue number5
DOIs
StatePublished - Sep 1 2007

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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