PMC2878681_01
Enhanced CT image. (a) The dilated main pancreatic duct (PD) (arrowhead) and fluid collection (arrow) surrounding the pancreas and the liver were demonstrated. (b) A pseudocyst (arrow) at the pancreatic head was revealed.
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However, laboratory data did not improve and enhanced CT revealed increase in fluid collection surrounding not only the pancreas but also the liver (Figure 1).
Endosonography-guided pancreatic duct drainage (ESPD): (a) endosonographic image, (b, c) X-ray image, and (d) endoscopic image. The PD was punctured via the body of the stomach with a 19-gauge needle (arrow) (a, b). A 7.2 F nasopancreatic duct drainage catheter (arrow) was placed (c, d).
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Tokyo, Japan), the PD was punctured via the body of the stomach with a 19-gauge needle (Echotip: Cook Corp., Winston-Salem, NC) (Figures 2(a) and 2(b)). Scientific Corp., Natick, MA, USA) was introduced into the sheath catheter and inserted into the PD. Subsequent to removing the sheath catheter while leaving the guidewire in situ, the puncture tract was dilated with a balloon catheter 4 mm in diameter (Maxforce: Boston Scientific), and a 7.2 F nasopancreatic duct drainage (NPD) catheter (HANACO MEDICAL Co., Ltd, Saitama, Japan) was placed (Figures 2(c) and 2(d)).
Prograde PD stenting: (a, b) X-ray image. Ten days after ESPD, a guidewire was passed through the papilla of Vater (a). A 7 F stent with a single duodenal pigtail (arrow) was inserted into the PD via the puncture tract (b).
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 Ten days after ESPD expecting mature fistula formation, a 0.035-inch guidewire (Jagwire: Boston Scientific Corp., Natick, MA, USA) was passed via the NPD catheter across the papilla of Vater using a duodenoscope (TJF-240: Olympus) under fluoroscopic guidance (Figure 3(a)). Tokyo, Japan) was inserted into the PD via the puncture tract after dilating the PD stenosis in the pancreatic head with a 7 F tapered catheter (Figure 3(b)).
(a) X-ray image, (b) endoscopic image. The stent was transpapillarily replaced with a 10 F straight stent (arrow) one week later.
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Co., Ltd.) one week later (Figure 4). Cytologic specimens obtained from the stricture of the PD were negative for malignancy.
Enhanced CT image. A reduction in diameter of the PD (arrow) and the disappearance of the pseudocyst were demonstrated.
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Six months later after the stent exchange, enhanced CT showed a reduction in diameter of the PD (from 13 to 9 mm) and the pseudocyst disappeared (Figure 5).