ABSTRACT
Disconnected pancreatic duct syndrome is a sequela of necrotizing pancreatitis or pancreatic trauma in which necrosis of a segment of the pancreas leads to lack of continuity between viable secreting pancreatic tissue (eg, body or tail) and the gastrointestinal tract. The endoscopic retrograde cholangiopancreatography showing total cutoff of the pancreatic duct along with an enhancing distal pancreas on contrast-enhanced computed tomography remains the criterion standard for diagnosis. Recently, the evolving literature supports a role for magnetic resonance cholangiopancreaticography, especially with secretin stimulation. A multidisciplinary approach is extremely important in the management of this condition. Conservative measures are usually not helpful, and interventional radiology, endoscopic, or surgical intervention is almost always needed for management of these patients. Recently, endoscopic ultrasonography-guided drainage procedures in conjunction with endoscopic retrograde cholangiopancreatography-assisted pancreatic duct stenting have emerged as a novel technique to manage this condition. The aim of this review was to give a detailed overview about the diagnosis and management of disconnected pancreatic duct syndrome with emphasis on the changing paradigm in endoscopic and surgical management.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Pancreatectomy , Pancreatic Ducts/surgery , Pancreatic Fistula/surgery , Stents , Abdominal Injuries/epidemiology , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Magnetic Resonance , Drainage , Humans , Necrosis , Pancreatectomy/adverse effects , Pancreatic Ducts/injuries , Pancreatic Ducts/pathology , Pancreatic Fistula/diagnosis , Pancreatic Fistula/epidemiology , Pancreatitis, Acute Necrotizing/epidemiology , Postoperative Complications/etiology , Predictive Value of Tests , Prevalence , Risk Factors , Syndrome , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJECTIVES: This study aimed to estimate outcomes of splanchnic vein thrombosis (SVT) in hospitalized patients with acute pancreatitis (AP). METHODS: This was a retrospective study (January 1996 to December 2006) via chart review. RESULTS: Over 10 years, 1.8% (45/2454) of patients with AP with a mean (SD) age of 58 (15) years were diagnosed with SVT. Splenic vein thrombosis was the most common form of SVT (30/45 patients, 67%). Seventeen patients were anticoagulated with heparin, when the SVT was diagnosed in the acute stage followed by oral anticoagulation (AC). The thrombosis that was most commonly anticoagulated was portal vein thrombosis in 11 (65%) of 17 patients. Of 17 patients in the AC group, 2 (12%) showed recanalization as compared with 3 (11%) of 28 patients in the non-AC group (P > 0.05). The mortality was 3 (7%) of 45 (2 from the AC group versus 1 in the non-AC group, P > 0.05). Two of these died of multiorgan failure, and the other, from septic shock. None of the deaths were due to bleeding complications. CONCLUSIONS: Splanchnic vein thrombosis occurred in 1.8% patients of AP. The use of AC was reasonably safe with no fatal bleeding complications. However, there was no significant difference in the recanalization rates in those with and without AC.
Subject(s)
Pancreatitis/complications , Portal Vein , Splenic Vein , Venous Thrombosis/complications , Acute Disease , Adult , Aged , Anticoagulants/therapeutic use , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pancreatectomy , Pancreatitis/surgery , Retrospective Studies , Splanchnic Circulation/drug effects , Splenectomy , Survival Rate , Treatment Outcome , Venous Thrombosis/drug therapy , Venous Thrombosis/mortalityABSTRACT
Pancreatitis is an inflammatory process with local and systemic manifestations. One such local manifestation is thrombosis in splanchnic venous circulation, predominantly of the splenic vein. The literature on this important complication is very sparse. This review offers an overview of mechanism of thrombosis, its pathophysiology, diagnosis, and management in the setting of acute as well as chronic pancreatitis.
