disconnected pancreatic duct syndrome (DPDS) is a recognized complication of acute necrotizing pancreatitis (ANP), whose incidence and impact on the evolution of pancreatic collections and metabolic prognosis remain poorly defined. This study aimed to describe the clinical characteristics, diagnostic methods, endoscopic management, and outcomes of patients with DPDS managed in our department.

A retrospective study was conducted between 2019 and October 2025, including all patients followed for DPDS complicating acute necrotizing pancreatitis (ANP). The data collected covered demographic characteristics, the etiology of ANP, diagnostic methods, therapeutic management, and the clinical outcomes.  

Among 63 patients admitted for ANP, four patients (two men and two women) had disconnected pancreatic duct syndrome (DPDS), representing an incidence of 6.3%. The median age was 47 years (range 23–68 years).

Acute necrotizing pancreatitis was of biliary origin in two patients (50%), alcoholic in one patient (25%), and metabolic in another (25%).

Clinically, all four patients presented with pancreatic-type abdominal pain (100%), associated with vomiting in three of them (75%).

AT admission, three patients met SIRS (systemic inflammatory response syndrome) criteria, which persisted beyond 48 hours in two patients.

Initial imaging showed acute pancreatitis stage E of Balthazar in three patients (CTSI = 8 in two and 6 in one) and stage C pancreatitis in the remaining patient. Peripancreatic collections were present in all patients, with an average size of 10 cm (range :3–16 cm).

The diagnosis of DPDS was made early in one patient during the CT scan to assess acute pancreatitis. In two others, it was made during an endoscopic ultrasound (EUS) performed for transmural drainage of an infected WON (walled-off necrosis), and incidentally in one patient who underwent EUS for suspected intraductal papillary mucinous neoplasm of the pancreas on MRI.

The mean time to diagnosis after the episode of acute pancreatitis was 41 days (3–120 days).

The ductal disconnection was located in the body of the pancreas in all cases.

Endoscopic management was performed in three cases: one patient was drained with two double -pigtail plastic stents. The second patient with a metal stent (hot Axios) with necrosectomy sessions, and replaced one month later by two double pigtail plastic stents. The third patient was drained with

a covered biflanged stent, replaced subsequently by double pigtail plastic stents.

One asymptomatic patient did not require treatment. All plastic stents, were 7 Fr/7cm , were retained long term to ensure permanent drainage. No per-procedure complications were reported.

The outcome was favorable in all patients, marked by the disappearance of pain and regression of collections. One patient presented a new pancreatitis episode on distal MPD stricture    

After a median follow-up of 8 months (range:2–23 months), two patients developed new-onset diabetes mellitus.

No cases of exocrine pancreatic insufficiency or mortality were observed.   

Although limited by a small sample size, our study highlights the efficacy and safety of endoscopic treatment in patients with post-necrotizing pancreatitis DPDS, allowing surgery to be avoided in the majority of cases, with minimal morbidity and no mortality.

DPDS could be a risk factor for new onset diabetes, highlighting the need for prolonged metabolic monitoring. Radiologists must remain vigilant and systematically consider this diagnosis in cases of extensive necrotizing pancreatitis in order to avoid diagnostic delays and the onset of complications.