Pancreatic Leak After Endoscopic Ultrasound Guided Fine Needle Aspiration Managed by Transpapillary Pancreatic Duct Stenting

摘要

Context Endoscopic ultrasonography guidedfine needle aspiration (EUS-FNA) is a front line test used for the diagnosis ofsolid as well as cystic lesions of the pancreas. This procedure is fairly welltolerated and associated with minimal complications. Local complications suchas perforation and pancreatitis have been reported with EUS-FNA, albeit rarely.Although pancreatic duct injury can occur during EUS-FNA, symptomatic pancreaticduct leak as a complication of this procedure has never been reported. Case reportWe present a 67-year-old patient who developed symptomatic ascites afterEUS-FNA of a pancreatic neck lesion that required several paracenteses.Analysis of the ascitic fluid revealed that the fluid amylase and lipase levelswere very high consistent with pancreatic ascites. An endoscopic retrogradepancreatography was subsequently performed that documented the presence of a pancreaticduct leak in the neck. The pancreatic duct leak and the ascites resolved afterplacing a pancreatic duct stent. Conclusion A clinically significantpancreatic leak can occur as a rare complication of EUS-FNA that can beeffectively managed by endoscopic retrograde pancreatography and placement of atranspapillary pancreatic duct stent.