Endoscopically placed pancreatic stent in a patient with concomitant two locations of main pancreatic duct disruption following pancreatic trauma

Severe pancreatic trauma involving disruption of the main pancreatic duct usually requires operative management. Recently, the successful non-operative treatment of proximal main pancreatic duct injuries by pancreatic stent has been described as having good results. Computed tomography of a 36-year-old man who sustained a blunt abdominal trauma in a motor vehicle accident disclosed a large amount of fluid in the cavity of the lesser sac, as well as a laceration of the pancreatic parenchyma at the pancreatic neck. Without definite evidence of pancreatic duct injury during laparotomy, no pancreatic resection was performed. However, postoperative endoscopic retrograde cholangiopancreatography showed 2 sites of main pancreatic duct disruption at the pancreatic neck and body, respectively. The first attempt for endoscopic pancreatic drainage failed with the endoscopic nasopancreatic drainage tube penetrating into the peritoneal cavity through the distal disruption site. A 5-French pancreatic stent was used for another attempt and successfully passed through the proximal disruption site with its tip located just proximal to distal disruption site. The patient improved steadily and was discharged uneventfully. The presenting case demonstrated that the endoscopically placed pancreatic stent was highly effective for the management of severe pancreatic trauma even though there were 2 sites of main pancreatic duct disruption, and pancreatic resection could be avoided.