Management of disconnected pancreatic duct syndrome: current state of the art

Disconnected pancreatic duct syndrome (DPDS) refers to a complete loss of continuity of the main pancreatic duct between the viable, secreting parenchyma and the downstream pancreas. It represents an underrecognized but relatively frequent complication of necrotizing acute pancreatitis and, more rarely, pancreatic trauma. Diagnosis is based on the identification of a necrotic area of at least 2 cm, the presence of viable upstream parenchyma, and contrast extravasation during pancreatography. The main clinical manifestations include persistent or recurrent pancreatic fluid collections, external pancreatic fistulas, and pancreatic ascites. Cross-sectional imaging modalities such as MRI and CT are the key diagnostic tools. Management of DPDS is primarily endoscopic, particularly through endoscopic ultrasound-guided transmural drainage of pancreatic collections, which enables long-term diversion of pancreatic secretions into the digestive tract. Prolonged placement of double-pigtail plastic stents appears to reduce the risk of recurrence. Surgery remains an option in cases of failure of endoscopic approaches. DPDS should be systematically investigated following necrotizing acute pancreatitis. Early recognition and an appropriate, tailored therapeutic strategy help to limit complications and improve long-term outcomes.