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CC BY 4.0 · Endoscopy 2025; 57(S 01): E1338-E1340
DOI: 10.1055/a-2739-2588
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Traumatic pancreatic injury successfully bridged through a giant pancreatic pseudocyst

Authors

  • Tomohisa Iwai 

    1   Department of Gastroenterology, Fujisawa City Hospital, Kanagawa, Japan (Ringgold ID: RIN36993)

  • Masaki Nishimura

    1   Department of Gastroenterology, Fujisawa City Hospital, Kanagawa, Japan (Ringgold ID: RIN36993)

  • Megumi Tsukamoto

    1   Department of Gastroenterology, Fujisawa City Hospital, Kanagawa, Japan (Ringgold ID: RIN36993)

  • Yusuke Ozaki

    1   Department of Gastroenterology, Fujisawa City Hospital, Kanagawa, Japan (Ringgold ID: RIN36993)

  • Shigeru Iwase

    1   Department of Gastroenterology, Fujisawa City Hospital, Kanagawa, Japan (Ringgold ID: RIN36993)

  • Shin Maeda

    2   Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (Ringgold ID: RIN26438)
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Pancreatic injury is a rare form of abdominal trauma and usually requires surgery for deep damage with axial deviation [1] [2]. Recently, endoscopic pancreatic stenting for the disconnected pancreatic duct syndrome (DPDS) has been attempted as a minimally invasive treatment [3] [4] [5], but difficult situations are often encountered. Here, we present a case of successful rendezvous stenting through a giant pancreatic pseudocyst ([Video 1]). A 9-year-old boy fell off his bicycle and had handlebar trauma. He had a duodenal perforation and severe damage to the pancreas, resulting in DPDS ([Fig. 1]). He first underwent mesh repair surgery for duodenal perforation, and endoscopic treatment for DPDS was unsuccessful on two attempts ([Fig. 2]). Two weeks later, MRCP revealed a small pseudocyst, and conservative management was chosen. The patient developed postprandial abdominal pain and maintained on total parenteral nutrition (TPN) for 2 months. He was transferred to our hospital 2 months after the injury, still on TPN. MRCP performed at our hospital revealed that the pancreatic pseudocyst had enlarged to 45 mm ([Fig. 3]). Because single-session bridging was considered impossible, two stents were placed in the pseudocyst – one via the transpapillary route and one via EUS-guided pancreatic duct drainage – to establish two points of communication between the pseudocyst and the main pancreatic duct ([Fig. 4]). In the second session, after balloon dilation of the distal connecting part of the pancreatic duct, a guidewire inserted from the papilla of Vater was advanced across the pseudocyst into the pancreatic duct of the tail, and a transpapillary pancreatic stent was successfully placed through the pseudocyst ([Fig. 5]). To the best of our knowledge, this is the first report of successful stent bridging through a giant pancreatic pseudocyst caused by trauma.

Traumatic pancreatic injury successfully bridged through a giant pancreatic pseudocyst.Video 1

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Fig. 1 Computed tomography revealed disconnected pancreatic duct syndrome secondary to handlebar trauma (arrow). a Axial image. b Coronal image.
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Fig. 2 Fluoroscopic images of endoscopic retrograde cholangiography. Endoscopic pancreatic duct stenting was not achieved after two attempts. a First attempt, day 1 post-injury. b Second attempt, day 20 post-injury.
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Fig. 3 Magnetic resonance cholangiopancreatography demonstrated a pancreatic pseudocyst at the site of the trauma. a A small pancreatic pseudocyst was formed shortly after the injury. (b) The pseudocyst enlarged to 45 mm by the time the patient was transferred to our hospital.
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Fig. 4 Fluoroscopic images during pancreatic stenting in the first session. a EUS-guided pancreatic duct drainage was performed from the distal pancreatic duct. b The stricture was dilated using a drill dilator. c From the papillary side, the stricture was dilated with a balloon dilator. d Two pancreatic stents were placed in the pancreatic pseudocyst.
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Fig. 5 Fluoroscopic images of endoscopic retrograde cholangiography during the second session. a A guidewire was successfully advanced into the distal pancreatic duct through the shrunk pancreatic pseudocyst. b Transpapillary bridging with a single stent was achieved, and the transgastric stent was removed.

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Publication History

Article published online:
21 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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