Extracorporeal rendezvous technique combining endoscopic retrograde pancreatography with endoscopic ultrasound for main pancreatic duct disconnection arising from acute necrotizing pancreatitis: a case report

摘要

A 45-year-old man with a history of heavy alcohol con- sumption presented with hematemesis and abdominal pain. Serum amylase and C-reactive protein levels were elevated in his biochemical examination. A CT of his abdomen demonstrated an acute necrotic collection around the pancreas (Fig. 1), and EGD demonstrated fistula in the duodenal bulb. Therefore, he was diagnosed with acute pancreatitis with duodenal fistula. He underwent emergency Billroth II gastrectomy and had a percutaneous drainage tube placed near the head of the pancreas. He recovered from acute pancreatitis and duodenal fistula; however, there was persistent drainage of pancreatic juice at 200 to 300 mL/day. For further evaluation, the percutaneous drain was injected with contrast to reveal the communication with the pancreatic duct; however, there was no opacification of the pancreatic duct in the head, confirming pancreatic duct disconnection (Fig. 2). Initially, endoscopic retrograde pancreatography was performed; however, we were unable to opacify the main pancreatic duct (MPD) upstream from the disconnection (Fig. 3). Subsequently, EUS-guided pancreatography was performed to visualize and access the MPD upstream from the disconnection.