Disrupted pancreatic duct treated with a combination of endoscopic cystoduodenostomy and pancreatic duct fistualization through a pseudocyst wall using a lumen-apposing metal stent.

Management of disconnected pancreatic duct syndrome is complex and is increasingly approached using emerging endoscopic techniques. Herein, we present a case of recurrent pancreatitis in an elderly woman complicated by pseudocyst formation and complete pancreatic duct disruption. Her condition was treated with a novel combination of transpapillary stenting and cystduodenostomy in which a pancreatic duct stent was placed into an opening in the pseudocyst wall through a lumen-apposing metal stent. This allowed for effective drainage into the gastrointestinal tract and resolution of duct disruption. Post-procedure, the patient has had recovery of nutritional status and no further recurrence of pancreatic fluid collection. Endoscopic approaches to complete pancreatic duct disruption represent a viable and less invasive alternative to surgical management in selected cases.