Severe pancreatic injury with total disruption of main pancreatic duct successfully managed by multi‐stage endoscopic therapy: a case report

Background: The management of pancreatic injury is not well-established. Recently, endoscopic therapy has been reported as a treatment option for main pancreatic duct disruption. Case Presentation: A 68-year-old man presented to our hospital and was diagnosed with severe traumatic pancreatic injury that developed 2 days prior. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct disruption. Although initial stenting to the distal main pancreatic duct was not achieved because of the widespread intermediate fluid collection, an endoscopic naso-pancreatic drainage tube was successfully inserted into via the main duodenal papilla. After drainage, the endoscopic naso-pancreatic drainage tube was replaced with an endoscopic retrograde pancreatic drainage tube, and a stent was successfully placed into the distal main pancreatic duct via the minor papilla. Conclusion: We report a case of severe pancreatic injury managed using multi-stage endoscopic therapy that could be a possible treatment strategy for pancreatic injury with total main pancreatic duct disruption.