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

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.

Automated summary

Disconnected pancreatic duct syndrome (DPDS) is a significant complication of acute necrotizing pancreatitis (ANP) associated with long-term morbidity and mortality. While endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard for diagnosing and treating DPDS patients, a noninvasive diagnosis based on radiological tests is desirable. Radiological literature on DPDS diagnosis is limited, with substantial ambiguity in the definitions.