Minor-papilla rescue stenting for pancreatic duct disruption presenting as massive pancreatic ascites

Pancreatic duct disruption may cause massive pancreatic ascites and mimic malignant or inflammatory peritoneal disease. A 57-year-old man developed progressive abdominal distension after blunt upper-abdominal trauma. Ascitic-fluid amylase was markedly elevated, whereas magnetic resonance cholangiopancreatography showed only mild pancreatic duct dilatation without a visible leak. After approximately 20 days of unsuccessful conservative treatment, endoscopic retrograde pancreatography was performed. Following failed major-papilla cannulation, access through the minor papilla demonstrated a partial pancreatic duct disruption at the pancreatic neck. The guidewire was advanced into the upstream pancreatic duct, and a 5-Fr × 7-cm single-pigtail plastic stent was placed across the leak. Ascitic-fluid amylase rapidly decreased and the ascites markedly improved. The stent was removed 3 months later, and no recurrent ascites occurred during the subsequent 6-month follow-up. Minor-papilla access may provide a rescue route for bridging pancreatic duct disruptions when conventional access fails.