Radiological criteria for disconnected pancreatic duct syndrome: a targeted literature review

ABSTRACT

Introduction

In patients with acute necrotizing pancreatitis (ANP), parenchymal necrosis may involve the pancreatic duct, isolating a segment of the pancreas that remains functional but drains its secretions into the peripancreatic fluid collections, leading to disconnected pancreatic duct syndrome (DPDS). DPDS is an important complication of ANP associated with long-term morbidity and mortality. Unfortunately, this critical entity is under-recognized by radiologists. Endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard for diagnosing and treating such patients. However, considering the invasiveness of the ERCP, a noninvasive diagnosis based on radiological tests is desirable. Radiological literature concerning the diagnosis of DPDS is scarce, and there is substantial ambiguity regarding the radiological definitions of DPDS.

Areas covered

Considering the scarcity of published literature regarding the reliable radiologic diagnosis of DPDS, we performed a thorough review of the existing literature to identify definitions and features of this entity on computed tomography (CT) and magnetic resonance imaging (MRI).

Expert opinion

Existing literature regarding radiologic diagnosis of DPDS was reviewed and analyzed and a comprehensive imaging definition of DPDS was proposed.

KEYWORDS:

• Pancreatitis
• disconnected pancreatic duct
• imaging

Article highlights

• DPDS is a significant complication of acute necrotizing pancreatitis.

• Early and accurate diagnosis is essential to prevent acute (SIRS and organ failure) and chronic complications (including recurrent pancreatitis and pancreatic fistulae).

• ERCP is currently considered the gold standard for the diagnosis of this entity. However, due to its invasive nature, reliable radiologic criteria are needed.

Since CECT and MRI are routinely used imaging modalities in patients with ANP, ambiguity regarding these definitions must be resolved.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.