Fig. 4

Disconnected pancreatic duct syndrome managed with transcavitary duct stent placement. Patient 8 presented with severe necrotizing pancreatitis. a Coronal reconstruction of abdominal CT scan shows a very large peri-pancreatic walled-off necrosis (WON). b Abdominal radiograph during contrast injection into the WON cavity 2 weeks of drainage shows improvement but persistence of amorphous filling defects caused by debris (arrowheads). c Radiograph during percutaneous necrosectomy shows a forceps introduced through a peel-away sheath grasping the large conglomerates of necrotic and fibrinous material during the process of evacuation. d After resolution of the peri-pancreatic WON a cavitygram shows communication with the pancreatic duct (arrowheads) through a focal disruption (curved arrow) at the neck of the pancreas. e Plastic stent in transit through the percutaneous tract is faintly visible as it is advanced in a folded configuration (arrowheads) over parallel guidewires, one directed towards the pancreatic tail and the other through the ampulla. f CT scan shows the plastic stent appropriately positioned in the pancreatic duct bridging the head and tail segments of pancreatic duct. After one month the stent was removed endoscopically and 6 months later the patient had no recurrence of peri-pancreatic abnormalities and no need for pancreatic enzyme supplementation