case_images: PMC9357522_01
case_images: A 20-year-old patient of acute necrotizing pancreatitis presenting with complication of disrupted pancreatic duct syndrome: Ultrasound abdomen image (A) Shows a large well-defined hypoechoic collection in suprapancreatic region at neck and body region (red arrow) compressing them inferiorly with few hyperechoic debris within (blue arrow) and showing no vascularity on color Doppler; (B) Reveals extension of collection superomedially segment III (yellow arrow) of the left lobe liver; CECT axial image of abdomen; (C) Reveals a large well-defined intrapancreatic hypodense lesion (red arrow) replacing pancreatic parenchyma in neck and body region s/o walled-off necrosis and another well-defined hypodense lesion in the left lumbar region (blue arrow) closely abutting above collection s/o extrapancreatic walled-off necrosis with normal proximal MPD (yellow arrow); (D) Reveals normal tail of pancreas in morphology and enhancement pattern and distal main pancreatic duct is opening into collection with duct making an angle of 90  with collection (green arrow); T2 HASTE axial section of MRCP; (E) Reveals a large hyperintense lesion in the pancreatic neck and body region with multiple T2-hypointense-dependent non liquefied debris within s/o walled-off necrosis (yellow arrows). Another well-defined heterogeneously hyperintense lesion in the left lumbar region is extrapancreatic collection (red arrows). The distal MPD at tail region making an angle of 90  with the collection and also opening into it suggestive of disconnected pancreatic duct syndrome (green arrow); T2 HASTE coronal thick multislice sequence of MRCP; (F) Reveals nonvisualization of MPD (red arrow) in neck and body region with normal caliber MPD at head and tail region
case_images: ejohg-12-60-g001.jpg
case_images: PMC9357522_01_ejohg-12-60-g001.jpg
case_images: F1
case_images: Ultrasonography (USG) of the whole abdomen with spleno-portal axis Doppler reveals extensive collection extending from lesser sac to hypogastrium with internal echoes resembling pancreatic necrotic collection, which was communicating with a collection in a left lobe of the liver (Figs 1A and B). There was evidence of walled necrosis in the peripancreatic region and ascites (Figs 1C and D). T2WI with few dependent hypointense nonliquefied debris within s/o walled-off necrosis with cholelithiasis. There was communication between residual MPD with the pancreatic cystic collection, suggesting DPDS (Figs 1E and F).
case_images: PMC9357522_02
case_images: Axial CECT image of the abdomen in a patient with a history of blunt trauma abdomen reveals discontinuity in pancreatic parenchyma in its neck region replaced by an ill-defined collection (red arrow). Distal main pancreatic duct is dilated (yellow arrow) and opens into the collection with duct making an angle of 90  with collection (green arrow). Disconnected pancreatic duct syndrome
case_images: ejohg-12-60-g002.jpg
case_images: PMC9357522_02_ejohg-12-60-g002.jpg
case_images: F2
case_images: IV) with main pancreatic ductal disconnection and pancreatic and peripancreatic collection (Figs 2A and B). Immediate exploratory laparotomy with peritoneal lavage and bilateral drain placement was done.