Management of the late effects of disconnected pancreatic duct syndrome: A case report

Figure 1 Computed tomography image showing the development of walled-off necrosis in the pancreatic neck region when severe acute necrotizing pancreatitis occurred 7 years prior.

Figure 2 Computed tomography scan taken at 7 years after severe acute necrotizing pancreatitis. A: Computed tomography (CT) scan showing spread of the pancreatic fluid collection to the aorta with surrounding inflammation and the appearance of ulcer-like blood flow in the aortic aneurysm thrombus (yellow arrow); B: The CT scan also shows splenic vein occlusion (yellow arrow; B) and venous dilation around the residual stomach; C: The shape of the pancreatic fluid collection is narrow around the stomach (yellow arrow), although it shows extensive spread.

Figure 3 Pancreatogram during a double-balloon endoscopic retrograde cholangiopancreatography shows complete pancreatic duct disruption (yellow arrow).

Figure 4 Endoscopic ultrasound-guided drainage. A: A linear array echo-endoscope shows many vessels surrounding the pancreatic fluid collection and stomach; B, C: The pancreatic fluid collection is punctured using a 19-gauge needle, carefully avoiding the vessels (B), and a double pigtail catheter (6 French/4 cm) is inserted transmurally (C).

Figure 5 The inflammation further improved after the procedure.