Percutaneous Embolization of the Pancreatic Duct with Cyanoacrylate Tissue Adhesive in Disconnected Duct Syndrome

Abstract

Traditionally, patients with chronic end-pancreatic fistulas caused by pancreatic necrosis have been treated with long-term percutaneous catheter drainage and/or surgical procedures such as resection or open drainage. With surgical treatment, the endocrine and exocrine functions of the removed pancreatic segment are sacrificed. Surgery in this patient population presents additional risks because of the inflammatory changes of pancreatitis and associated venous thromboses. The authors devised a method of percutaneous embolization of the pancreatic duct in a patient with catheter-dependent pancreatic fistula who wished to avoid surgery. The procedure was performed under fluoroscopic guidance with use of a microcatheter and wire system to access the duct, which was embolized with opacified n-butyl cyanoacrylate tissue adhesive. After 1 year of surveillance, the patient remains symptom-free. There has been no need for replacement of the drainage catheter and no further intervention has been performed.