COMPLETE DISRUPTION OF THE MAIN PANCREATIC DUCT - ENDOSCOPIC MANAGEMENT

Background: Complete disruption of the main pancreatic duct is an unus ual event in the course of acute or chronic pancreatitis. Endoscopic m anagement has already proven effective in the treatment of partial rup tures. Methods: Thirteen patients presented over a 7-year period with acute (9 patients) or chronic (4 patients) pancreatitis complicated by complete disruption of the main pancreatic duct and cyst formation. E ndoscopic treatment was attempted in 12. Treatment varied depending on the site of the rupture and accessibility of the pseudocyst and consi sted either of transpapillary drainage (3), cystogastrostomy (3), cyst oduodenostomy (2), or combined procedures (4) when one of these proced ures did not induce significant decrease in collection size. Long-term results were obtained by observing the patients with ultrasound, CT, ERCP, and clinical evaluation. Results: Short-term results were excell ent with complete cyst resolution and clinical recovery in all but one patient treated by endoscopy. Two patients had pseudocyst infection s uccessfully treated by drainage and antibiotics. Longterm follow-up wa s available for 11 patients (mean duration, 30.2 months; range, 12 to 72 months) without relapsing clinical symptoms or pseudocyst. Conclusi ons: Endoscopic management is effective and safe for treating patients with complete main pancreatic duct disruption. A double drainage comb ining transpapillary drainage and cystoenterostomy must be done in sel ected instances, especially when rupture occurs in the setting of chro nic pancreatitis with stricture or stone distal to the rupture.