[Disconnected Pancreatic Duct Syndrome: An Underdiagnosed Complication of Severe Necrotizing Pancreatitis]

Disconnected pancreatic duct syndrome (DPDS) was described in 1991. It consists of a rupture of the main pancreatic duct, with the formation of fluid connections alimented by the secretion of disconnected pancreatic segments. Its treatment is challenging, and the diagnosis is frequently established with considerable delay.

To describe our experiences with the diagnosis and treatment of DPDS.

Observational retrospective study of clinical files of patients admitted to our hospital between 2015 and 2024 with DPDS diagnosis. Analysis of demographic data, interventions, and late outcomes of patients.

21 patients were included, 15 males, aged 53 years (range 24-76). All patients had severe necrotizing pancreatitis. The diagnostic delay of DPDS was 20 (range 1-432) weeks. None of the patients was sent with an established diagnosis. All patients required multiple endoscopic and/or radiologic interventions, three of which were operated on. One patient died in the acute phase. New onset diabetes mellitus was observed in 11 patients; 5 of them required insulin treatment. Exocrine pancreatic insufficiency was detected in 12 cases. One patient died after a nine-year follow-up.

DPDS is a frequently overlooked complication of necrotizing pancreatitis. Management requires multiple minimally invasive interventions, with frequent relapses. Mortality is low and late consequences include exocrine and endocrine pancreatic insufficiency.