Resolution of pancreatic ductal disruption through endoscopic ultrasound (EUS)-guided Rendez-vous in a patient with pancreas divisum.

Abstract

A 73-year-old woman presented with a pancreas divisum was admitted for acute pancreatitis. Abdominal CT was performed due to a torpid evolution with fever and oral intolerance, demonstrating necrosis and ductal disruption in the pancreatic neck. An ERCP was attempted, however, the minor papilla (MP) could not be identified because of the presence of edematous duodenal folds. EUS revealed ductal disruption and the pancreatic duct was punctured using a 22G needle at the level of the body-tail junction (<2 mm). Then, rendez-vous was completed by cannulating the MP with a rail technique and a pancreatic stent was placed. Given the persistence of oral intolerance secondary to the duodenal parietal inflammatory component, EUS-guided gastrojejunostomy was performed with a 20 mm luminal apposition stent. The patient exhibited progressive clinical improvement and was discharged following a control ERCP, which confirmed resolution of the ductal disruption and significant improvement of the duodenal inflammatory changes. Consequently, the endoscopic gastrojejunostomy was reversed.