Endoscopic management of pancreatic duct disruption following a bullet injury: a case report.

CONTEXT A pancreatic fistula is the most common complication of pancreatic injury. Although spontaneous closure of pancreatic ductal disruption has been reported, surgical treatment is accepted as the single most carried-out intervention in major ductal injury. We report a case of pancreatic duct disruption due to a bullet injury managed successfully by endoscopic pancreatic duct stenting. CASE REPORT A 28-year old male sustained a bullet injury leading to proximal pancreatic duct disruption with leakage of dye. After a month of unsuccessful conservative management, graded endoscopic pancreatic duct stenting was carried out, leading to closure of the leak. The patient has gained 15 kilograms of weight at one year of follow-up without any complications. CONCLUSION This is probably the first case of successful endoscopic management of pancreatic duct disruption due to a bullet injury. In carefully selected patients, successful non-surgical management of traumatic pancreatic duct disruption is feasible.