A 32-year-old alcoholic man diagnosed as having acute necrotizing pancreatitis and
being managed conservatively developed high-grade fever not responsive to intravenous
antibiotics. A percutaneous catheter inserted into the large, infected acute necrotic
collection drained frank pus. The patient gradually improved and contrast-enhanced
computed tomography (CECT) 3 weeks later revealed a marked reduction in the size of
the collection. The transgastric route of the percutaneous catheter was visible on
the CECT scan. The catheter continued to drain 300 – 500 mL of clear pancreatic juice
and 4 weeks later the patient underwent endoscopic retrograde pancreatography (ERP).
This revealed a complete pancreas divisum with partial disruption of the dorsal duct.
A bridging 5-Fr stent was placed through the minor papilla and the patient showed
marked improvement, with the external drainage of pancreatic juice subsiding after
2 weeks. The percutaneous catheter was thereafter removed. After another 4 weeks,
the patient underwent another ERP for removal of the stent and to document healing
of the ductal disruption. During the passage of the duodenoscope into the stomach
a stentlike foreign body was seen in the stomach, protruding through the posterior
wall ([Fig. 1]). The transpapillary stent placed a few weeks earlier was seen at the papilla but
the flanges had migrated inwards ([Fig. 2]). Fluoroscopic examination revealed that the transpapillary stent had migrated into
the stomach through the pancreatic duct disruption, following the route created by
the transgastric percutaneous catheter ([Fig. 3]). The stent was removed via the minor papilla ([Fig. 4]) and a pancreatogram revealed persistence of ductal disruption. A bridging 5-Fr
transpapillary stent was placed. ERP was repeated 4 weeks later and revealed healing
of both the ductal disruption and the fistulous opening in the stomach.
Fig. 1 One end of a stent protruding into the stomach in a 32-year-old alcoholic man with
acute necrotizing pancreatitis.
Fig. 2 The other end of the stent was at the minor papilla.
Fig. 3 a Fluoroscopic image taken with the endoscope tip close to the gastric end of the stent.
b Fluoroscopic image taken with the endoscope tip close to the papillary end of the
stent.
Fig. 4 Endoscopic view of the stomach following stent removal.
Transpapillary stents and nasopancreatic drains have been successfully used for healing
of pancreatic ductal disruptions. Stent treatment may be associated with significant
complications such as infection, stent block, duct perforation, migration, and stent-induced
ductal changes [1].
Endoscopy_UCTN_Code_CPL_1AK_2AD
