Síndrome del ducto pancreático desconectado

Cirugía Española (Impact Factor: 0.74). 01/2014; 92(1):4–10.

ABSTRACT Disconnected pancreatic duct syndrome (DPDS) is characterized by disruption of the main pancreatic duct with a loss of continuity between the pancreatic duct and the gastrointestinal tract caused by ductal necrosis after severe acute necrotizing pancreatitis treated medically, by percutaneous drainage, or necrosectomy.
There are no clear epidemiological data on the real incidence of DPDS; approximately 10 to 30% of patients with severe acute pancreatitis could develop DPDS. The existing literature is scarce, the terminology is confusing and therapeutic algorithms are not clearly defined. Both endoscopic and surgical management have been described.
We have performed a sytematic review of the literature on DPDS.

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Available from: Jose Manuel Ramia-Angel, Feb 24, 2014
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    ABSTRACT: Limited published data exist that address the incidence and outcomes of patients with complete pancreatic-duct disruption. Report on a single-center experience with this entity that emphasizes the feasibility of endoscopic therapy and long-term outcomes. Retrospective analysis. Tertiary-care medical center (Portland, Maine). A total of 189 patients with pancreatic-fluid collections and/or pancreatic fistulas were retrospectively evaluated for the presence of a disconnected pancreatic tail. Patients meeting the definition of disconnected pancreatic tail syndrome (DPTS) with a minimum of 6 months' follow-up were analyzed. Thirty of 189 patients (16%) met criteria for DPTS. Thirty-six drainage procedures were performed on 29 patients (mean 1.2 procedures per patient). In 22 of 29 patients (76%), the initial drainage procedure was successful. However, recurrent fluid collection(s) developed in 11 of 22 patients (50%) and was seen in those treated surgically and endoscopically. Disruption in the tail (n = 3) was uncommon but invariably required no surgical intervention. The median follow-up was 38 months (range 3-94 months). Diabetes mellitus developed in 16 of 30 patients (53%); 15 of 30 patients (50%) had left-sided portal hypertension; 16 of 30 patients (53%) continue in active medical or surgical follow-up for recurrent symptoms attributable to the disconnected pancreatic tail. Of patients with a pancreatic-fluid collection and/or fistula, 16% will also have a disconnected pancreatic tail. Endoscopic and surgical drainage techniques are typically initially successful, but both suffer from a high rate of recurrence in the setting of DPTS. The majority of patients will require long-term follow-up because of complications and/or ongoing symptoms.
    Gastrointestinal Endoscopy 05/2008; 67(4):673-9. DOI:10.1016/j.gie.2007.07.017 · 5.37 Impact Factor
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    ABSTRACT: Eighteen patients with active pancreatic ductal disruptions, including 14 with definable fluid collections, were treated with transpapillary pancreatic duct drains or stents. Twelve of these patients had undergone a previous percutaneous or surgical pancreatic drainage procedure or both, and 8 had long-term drainage tubes in chronic fistulous tracts. Transpapillary catheters could be placed across the ductal disruption or directly into the fluid collection in each case, and 16 of 18 patients had resolution of the disrupted pancreatic duct. Twelve of 14 fluid collections resolved. Complications were limited to mild exacerbation of pancreatitis symptoms in 2 patients and 2 patients who developed subsequent stent occlusion leading to recurrent pancreatitis (1 patient) or recurrent duct blowout with pseudocyst (1 patient). Nine patients had variably significant ductal changes attributable to pancreatic duct stents. At a median follow-up of 16 months, 7 patients ultimately required surgery for ongoing pancreatic pain or residual/recurrent fluid collection. The transpapillary treatment of ongoing pancreatic ductal disruption with or without fluid collection has the potential to obviate surgery in some patients, change an urgent surgical procedure into an elective one, or even assist the surgeon in the performance of intraoperative pancreatography. Further study of this technique appears warranted and must be placed into the perspective of current therapies.
    Gastroenterology 06/1991; 100(5 Pt 1):1362-70. · 16.72 Impact Factor
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    ABSTRACT: The lack of ductal continuity between a viable pancreatic tissue and the gastrointestinal tract results in the disconnected pancreatic duct syndrome (DPDS). The purpose of our study is to describe accurately the imaging features of CT scanning and endoscopic retrograde pancreatography (ERCP) that define the DPDS. We conducted a retrospective analysis of the computed tomography (CT) and ERCP examinations in 26 consecutive patients with surgically proven disconnected pancreatic ducts treated over a 5-year period at our institution. Two abdominal radiologists concurrently defined the imaging features (presence and size of fluid collection along the course of the pancreatic duct, upstream enhancing pancreatic parenchyma, and ERCP abnormalities) via consensus for both exams. Patient demographics, etiology of pancreatitis, surgical treatment, initial CT interpretation, and the delay between symptom onset to correct diagnosis were recorded. A discrete, intrapancreatic fluid collection (average size = 27 cm2 (range, 4-74 cm2) along the course of the main pancreatic duct with upstream viable pancreatic parenchyma was identified by CT in 26 cases. ERCP showed ductal obstruction at the level of the intrapancreatic fluid collection in all patients with extravasation of contrast in 14 (54%). All patients were treated by operation: 15 (58%) by internal drainage into a Roux-en-Y limb of jejunum and 11 (42%) by distal pancreatic resection. No prior CT interpretation correctly identified DPDS. The average delay between symptom onset and definitive diagnosis was 9.3 months (range, 3-36 months). A discrete intrapancreatic fluid collection along the expected course of the main pancreatic duct with viable upstream pancreatic parenchyma suggests the diagnosis of DPDS. ERCP findings of ductal obstruction at the level of this fluid collection with or without contrast extravasation confirm this diagnosis. Treatment is surgical and requires either internal drainage or distal pancreatic resection for complete resolution.
    Journal of Computer Assisted Tomography 07/2003; 27(4):577-82. DOI:10.1097/00004728-200307000-00023 · 1.41 Impact Factor
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