Video presentation: hand-assisted laparoscopic distal pancreatectomy and splenectomy for disconnected pancreatic duct syndrome

Abstract

Background: Disconnected pancreatic duct syndrome is a condition resulting from necrosis of the pancreatic duct which causes discontinuity between viable secreting distal pancreatic parenchyma and the gastrointestinal tract. The persistent leakage of pancreatic fluid leads to recurrent collections, pancreatitis, and pseudocyst formation. This condition is most often caused by necrotizing pancreatitis and the diagnosis is often delayed, resulting in a prolonged, complicated course. The first line therapy is usually endoscopic stenting or drainage with surgery reserved for those patients whose symptoms do not resolve. Methods: We present the case of a 34-year old female with disconnected pancreatic duct syndrome whose treatment course is representative of the change in management of pancreatic pseudocysts and disconnected pancreatic ducts. Results: A decade ago, she had her initial episode of pancreatitis that resulted in a persistent pseudocyst which was surgically drained, as was frequently the treatment of choice at that time. Years later, she had recurrent pancreatitis, another pseudocyst, and was diagnosed with disconnected pancreatic duct syndrome. Endoscopic techniques failed to resolve her symptoms. She eventually required surgery, which was particularly challenging due to the recurrent bouts of pancreatitis, her previous surgical cyst-enterostomy, the endoscopic cyst- gastrostomy with an indwelling metal stent, and the pancreatic duct stent which had been placed to try to bridge the disconnected duct and drain the distal pancreas. Conclusion: Despite these challenges, the surgery was successfully completed using a hand- assisted laparoscopic technique to resect the distal disconnected pancreas.