Pancreatic duct leakage following emergency splenectomy treated by endoscopic pancreatic stenting through the minor papilla

A case of a 30 year-old woman is presented who underwent emergency termination of her pregnancy due to placental abruption. The life threatening bleeding provoked cardiac arrest which required complete cardiopulmonary resuscitation preoperatively. Also an emergency splenectomy was performed because of bleeding from the spleen. After long term intensive care she improved significantly when transferred to our hospital. A fluid collection found at the previous splenectomy site with high amylase level in the aspirate was drained by percutaneous US guided intervention. Pancreatic duct (PD) damage related to the previous splenectomy was suspected in the background. ERCP revealed contrast leak at the tail of PD suggesting the need of pancreatic stenting. The guide wire couldn't be advanced to the body of pancreas due to an acute angle but came back to the duodenum through the minor papilla. An approach via the minor papilla needed to be performed allowing good access to the body and tail of PD. 5 F 7 cm pancreatic plastic stent was inserted after minor papillotomy while a 5 F 5 cm stent draining the pancreatic head was placed through the major papilla. The yield of the percutaneous drain decreased significantly after the ERCP procedure. A small collection in the abdominal wall at the laparotomy site was aspired percutaneously and required antibiotic and antifungal treatment. Otherwise she improved significantly and was discharged without repeated abdominal surgery.