Disconnected Duct Syndrome: A Bridge to Nowhere

Disconnected duct syndrome (DDS) is defined by a complete discontinuity of the pancreatic duct, such that the secretions of pancreas distal to the discontinuity fails to drain into the duodenum. It usually follows acute necrostising pancreatitis. This duct disruption occurs predominately in the pancreatic neck region, which represents a watershed area that is vulnerable to perfusion abnormalities. Failure of the disconnected duct to drain its secretions leads to serious complications including fistula, peripancreatic collections, sepsis, pancreatic ascites and chronic disability inlcuding diabetes mellitus, malabsorption and portal hypertension. How do we manage DDS and mend this bridge to nowhere. This article reviews the etiology, presentation, investigation, management options and complications of this syndrome.