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Diagnosis and treatment of disconnected pancreatic duct syndrome: Single center experience

Yıl 2018, Cilt: 17 Sayı: 2, 66 - 69, 24.09.2018
https://doi.org/10.17941/agd.462636

Öz

Background and Aims: Disconnected pancreatic duct syndrome is characterized by the disruption. of the pancreatic duct. Although this syndrome is rare, it is an important cause of morbidity and mortality. Here we examined demographic characteristics, endoscopic retrograde cholangiopancreatography findings, and endoscopic treatment features of our patients with the diagnosis of disconnected pancreatic duct syndrome. Materials and Methods: This study was performed in the Endoscopic Retrograde Cholangiopancreatography Unit of the Türkiye Yüksek İhtisas Training and Research Hospital between January 2010 and January 2017. Patients who receive a diagnosis of disconnected pancreatic duct syndrome in an endoscopic retrograde cholangiopancreatography procedure were identified retrospectively. These patients were divided into two groups based on the location of their etiologic cause of pancreatitis. Patients with ductal distribution at the head and neck of the pancreas were defined as the distal group, whereas those with ductal distribution at the body and tail were defined as the proximal group. Results: Overall, 17 patients (median age 46, 14 males and 3 females) were included in the study. Twenty-seven endoscopic retrograde cholangiopancreatography procedures were performed in these patients. Acute pancreatitis was the etiologic cause in 9 patients. Other etiologic causes were chronic pancreatitis in 2 patients, trauma in 4 patients, and pancreatectomy in 2 patients. In acute pancreatitis, a biliary cause could be defined in 5 patients. Also, pseudocysts were diagnosed in 15 patients, whereas walled-off necrosis was diagnosed in 1 patient, and duct distribution was seen in the neck of the pancreas in 10 patients. The proximal and distal groups were not statistically different regarding both endoscopic retrograde cholangiopancreatography sessions and etiologic causes of pancreatitis (p=.215, p=.278, respectively). Conclusion: We found that acute pancreatitis is the most common etiologic cause of disconnected pancreatic duct syndrome and duct distribution was common at the neck of the pancreas similar to the literature. Both inappropriate diagnosis and delayed therapy can lead to increased morbidity and mortality in these patients.

Kaynakça

  • 1. Sandrasegaran K, Tann M, Jennings SG, et al. Disconnection of the pancreatic duct: an important but overlooked complication of severe acute pancreatitis. Radiographics 2007;27:1389-400.
  • 2. Tann M, Maglinte D, Howard TH, et al. Disconnected pancreatic duct syndrome: imaging findings and therapeutic implications in 26 surgically corrected patients. J Comput Assist Tomogr 2003;27:577-82.
  • 3. Fischer TD, Gutman DS, Hughes SJ, et al. Disconnected pancreatic duct syndrome: disease classification and management strategies. J Am Coll Surg 2014;219:704-12.
  • 4. Pelaez-Luna M, Vege SS, Petersen BT, et al. Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc 2008;68:91-7
  • 5. Varadarajulu S, Wilcox CM. Endoscopic placement of permanent indwelling transmural stents in disconnected pancreatic duct syndrome: does benefit outweigh the risks? Gastrointest Endosc 2011;74:1408-12.
  • 6. Lawrence C, Howell DA, Stefan AM, et al. Disconnected pancreatic tail syndrome: potential for endoscopic therapy and results of longterm follow-up. Gastrointest Endosc 2008;67:673-9.
  • 7. Neoptolemos JP, London NJ, Carr-Locke DL. Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis. Br J Surg 1993;80:94-9.
  • 8. Howard TJ, Rhodes GJ, Selzer DJ, et al. Roux-en-Y internal drainage is the best surgical option to treat patients with disconnected duct syndrome after severe acute pancreatitis. Surgery 2001;130:714- 21.
  • 9. Nadkarni NA, Kotwal V, Sarr MG, et al. Disconnected Pancreatic Duct Syndrome: Endoscopic Stent or Surgeon’s Knife? Pancreas 2015;44:16-22.
  • 10. Devière J, Bueso H, Baize M, et al. Complete disruption of the main pancreatic duct: endoscopic management. Gastrointest Endosc 1995;42:445-51.
  • 11. Larsen M, Kozarek RA. Management of Disconnected Pancreatic Duct Syndrome. Curr Treat Options Gastroenterol 2016;14:348-59.
  • 12. Rana SS, Bhasin DK, Rao C, et al. Consequences of long term indwelling transmural stents in patients with walled off pancreatic necrosis & disconnected pancreatic duct syndrome. Pancreatology 2013;13:486-90.

Kopuk pankreatik kanal sendromu tanı ve tedavisi: Tek merkez deneyimi

Yıl 2018, Cilt: 17 Sayı: 2, 66 - 69, 24.09.2018
https://doi.org/10.17941/agd.462636

Öz

Giriş ve Amaç: Kopuk pankreatik kanal sendromu pankreas kanalının bütünlüğünün bozulmasıyla karakterizedir. Nadir görülen bu sendrom önemli bir morbidite ve mortalite nedenidir. Biz bu çalışmada kliniğimizde kopuk pankreatik kanal sendromu tanısı olan hastaların demografik özelliklerini, endoskopik retrograd kolanjiopankreatografi bulgularını ve bu hastaların aldıkları endoskopik tedavileri araştırdık. Gereç ve Yöntem: Bu çalışma Türkiye Yüksek İhtisas Hastanesi Gastroenteroloji Kliniği, Endoskopik Retrograd Kolanjiopankreatografi Ünitesinde Ocak 2010-Ocak 2017 tarihleri arasında kopuk pankreatik kanal sendromu tanısı alan hastalarla yapıldı. Kopuk pankreatik kanal senromlu hastalar etiyolojilerindeki nedenin pankreatit olup olmamasına göre ikiye ayrıldı. Kanal rüptürü 10 hastada olmak üzere en sık pankreas boynunda izlendi. Kanal rüptürünün baş ve boyunda olduğu hastalar distal grup, gövde ve kuyrukta olduğu hastalar ise proksimal grup olarak tanımlandı. Bulgular: Toplam 17 hastada kopuk pankreatik kanal sendromu vardı. Bu hastaların yaş ortancası 46 olup 14 hasta erkek, 3 hasta kadındı. Bu hastalara toplamda 27 endoskopik retrograd kolanjiopankreatografi seansı uygulandı. Etiyolojik neden olarak 9 hastada akut pankreatit, 2 hastada kronik pankreatit, 4 hastada travma ve 2 hastada ise insülinomadan dolayı yapılan pankreatektomi etiyolojik neden olarak izlendi. Akut pankreatit öyküsü olan hastaların 5 tanesi biliyer orjinliydi. 17 hastanın 15’inde psödokist, 1 hastada ise walled-off nekroz vardı. Kanal rüptürünün distalde ve proksimalde olduğu hastalar arasında endoskopik retrograd kolanjiopankreatografi işlem sayısı ve pankreatite yol açan etiyolojik nedenler karşılaştırıldı ve anlamlı bir farklılık bulunmadı (sırasıyla p=0,215, p=0,278). Sonuç: Çalışmamızda literatürle uyumlu olarak kopuk pankreatik kanal sendromlu hastalarda en sık etiyolojik neden olarak akut pankreatit izlendi. Hastalarımızın çoğunda kopuk pankreatik kanal sendromu boyun kısmında lokalize olup bu bulgu da literatürle uyumluydu. Bu sendroma uygun tanı konulamaması ve gerekli tedavinin yapılamaması hastaların morbidite ve mortalitelerinde artışa yol açacaktır.

Kaynakça

  • 1. Sandrasegaran K, Tann M, Jennings SG, et al. Disconnection of the pancreatic duct: an important but overlooked complication of severe acute pancreatitis. Radiographics 2007;27:1389-400.
  • 2. Tann M, Maglinte D, Howard TH, et al. Disconnected pancreatic duct syndrome: imaging findings and therapeutic implications in 26 surgically corrected patients. J Comput Assist Tomogr 2003;27:577-82.
  • 3. Fischer TD, Gutman DS, Hughes SJ, et al. Disconnected pancreatic duct syndrome: disease classification and management strategies. J Am Coll Surg 2014;219:704-12.
  • 4. Pelaez-Luna M, Vege SS, Petersen BT, et al. Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc 2008;68:91-7
  • 5. Varadarajulu S, Wilcox CM. Endoscopic placement of permanent indwelling transmural stents in disconnected pancreatic duct syndrome: does benefit outweigh the risks? Gastrointest Endosc 2011;74:1408-12.
  • 6. Lawrence C, Howell DA, Stefan AM, et al. Disconnected pancreatic tail syndrome: potential for endoscopic therapy and results of longterm follow-up. Gastrointest Endosc 2008;67:673-9.
  • 7. Neoptolemos JP, London NJ, Carr-Locke DL. Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis. Br J Surg 1993;80:94-9.
  • 8. Howard TJ, Rhodes GJ, Selzer DJ, et al. Roux-en-Y internal drainage is the best surgical option to treat patients with disconnected duct syndrome after severe acute pancreatitis. Surgery 2001;130:714- 21.
  • 9. Nadkarni NA, Kotwal V, Sarr MG, et al. Disconnected Pancreatic Duct Syndrome: Endoscopic Stent or Surgeon’s Knife? Pancreas 2015;44:16-22.
  • 10. Devière J, Bueso H, Baize M, et al. Complete disruption of the main pancreatic duct: endoscopic management. Gastrointest Endosc 1995;42:445-51.
  • 11. Larsen M, Kozarek RA. Management of Disconnected Pancreatic Duct Syndrome. Curr Treat Options Gastroenterol 2016;14:348-59.
  • 12. Rana SS, Bhasin DK, Rao C, et al. Consequences of long term indwelling transmural stents in patients with walled off pancreatic necrosis & disconnected pancreatic duct syndrome. Pancreatology 2013;13:486-90.
Toplam 12 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Muhammet Yener Akpınar 0000-0003-0903-4664

Bülent Ödemiş Bu kişi benim 0000-0001-6763-791X

Adem Aksoy Bu kişi benim 0000-0003-3823-3654

Mustafa Kaplan

Orhan Coşkun Bu kişi benim 0000-0002-3124-9517

Yayımlanma Tarihi 24 Eylül 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 17 Sayı: 2

Kaynak Göster

APA Akpınar, M. Y., Ödemiş, B., Aksoy, A., Kaplan, M., vd. (2018). Kopuk pankreatik kanal sendromu tanı ve tedavisi: Tek merkez deneyimi. Akademik Gastroenteroloji Dergisi, 17(2), 66-69. https://doi.org/10.17941/agd.462636

test-5