EUS-guided pancreatic rendezvous for management of pancreaticopleural fistula with an undilated duct and pancreas divisum

作者：Aditya Kale, Sridhar Sundaram, Mayur Satai, Sidharth Harindranath, Love Garg, Mohit Aggarwal · 发表于：Endoscopic Ultrasound · 年份：2022 · DOI：10.4103/eus-d-21-00164 · 被引用次数：3 · 研究领域：Pancreatitis Pathology and Treatment、Gastrointestinal disorders and treatments、Pediatric Hepatobiliary Diseases and Treatments

A 33-year-old male, case of acute necrotizing pancreatitis, presented with a pancreatopleural fistula with massive right pleural effusion. There was persistent output from an intercostal drain in the right thorax. Magnetic resonance cholangiopancreatography showed pancreas divisum type II with leak from the tail of the pancreas tracking to the right pleura, with collection in the region of the head of the pancreas [Figure 1]. Endoscopic retrograde pancreatography was attempted twice through the minor papilla but failed despite precut sphincterotomy [Figure 2a]. EUS-guided rendezvous (RV) was considered due to failure of access. EUS showed 1.7-mm pancreatic duct (PD) in the body of the pancreas [Figure 2b], which was punctured using a 22G FNA needle [Figure 2c]. After contrast injection, 0.018” guidewire was passed across into the duodenum [Figure 2d]. Scope was changed to duodenoscope while maintaining guidewire position. The guidewire was drawn out through the duodenoscope using rat-tooth forceps. An endoscopic retrograde cholangiopancreatography cannula was then passed across into the PD and guidewire was changed to 0.025”, passed till the tail of the pancreas. Pancreatogram showed leak from the tail of the pancreas [Figure 3]. After sphincterotomy, 5 Fr pancreatic stent placed across the leak in tail region [Figure 4]. Intercostal drain output reduced to nil by day 7 and was removed on day 10. He was discharged after nutritional rehabilitation on day 14 after procedure.Fig...