Fig. 2

In a 56-year-old male, a year after severe necrotic-haemorrhagic AP, T2-weighted MRI (a) and contrast-enhanced MDCT (b) showed persistent ample regions of hyperintense, nonenhancing parenchymal necrosis (*). At another hospital, endoscopic ultrasound (EUS)-guided cystogastrostomy was initially performed, including positioning of a 3-cm-long, 12-mm-wide self-expanding metal stent (thick arrow in c). After obtaining incomplete regression of necrotic collection, repeated endoscopy at our institution included trans-stent necrosectomy and deployment of a plastic pigtail stent (thick arrow in d). After poor, prolonged clinical improvement, MRCP (e) showed mild MPD dilatation at the pancreatic head (arrow) and segmental discontinuity at the body. Diagnosis of disconnected pancreatic duct syndrome (DPDS) was confirmed during endoscopic retrograde cholangiopancreatography (ERCP, f) and definitively treated by positioning of a long stent (thick arrows in g) through the disrupted MPD, ultimately resulting in relieved complaints and laboratory changes (adapted from Open Access ref. no. [27])