title: Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases.
abstract: 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.
  
  
  METHODS
  A retrospective review of the Mayo Clinic endoscopy and hospital service database.
  
  
  METHODS
  Tertiary-referral center.
  
  
  METHODS
  We identified 31 DPDS cases from 1999 to 2006.
  
  
  METHODS
  Endoscopic drainage of pancreatic-fluid collections.
  
  
  METHODS
  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.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors: Mario
authors: M
authors: Pelaez-Luna
authors: Santhi Swaroop
authors: SS
authors: Vege
authors: Bret T
authors: BT
authors: Petersen
authors: Suresh T
authors: ST
authors: Chari
authors: Jonathan E
authors: JE
authors: Clain
authors: Michael J
authors: MJ
authors: Levy
authors: Randal K
authors: RK
authors: Pearson
authors: Mark D
authors: MD
authors: Topazian
authors: Michael B
authors: MB
authors: Farnell
authors: Michael L
authors: ML
authors: Kendrick
authors: Todd H
authors: TH
authors: Baron
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods*; D004322:Drainage / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000473:pathology / Q000601:surgery; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome