Emergency Partington-Rochelle Procedure for Hemorrhagic Peritonitis Due to Stent Migration Following Endoscopic Ultrasonography-Guided Pancreatic Duct Drainage.

Endoscopic ultrasonography-guided pancreatic duct drainage (EUS-PD) has become a valuable alternative to conventional retrograde approaches in treating chronic pancreatitis, particularly in cases where transpapillary access is technically unfeasible. Although generally considered safe and effective, EUS-PD can lead to rare but serious complications, such as stent migration, hemorrhage, and peritonitis. The surgical management of these adverse events remains inadequately documented in the clinical literature. We present the case of a 72-year-old man with a long-standing history of alcohol-related chronic pancreatitis and pancreatic diabetes who developed severe epigastric pain due to multiple intraductal pancreatic stones. Several attempts at endoscopic retrograde pancreatic lithotomy failed due to anatomical difficulties. EUS-PD was subsequently performed, and a covered self-expandable metal stent was placed transgastrically into the main pancreatic duct (MPD). Immediately after deployment, bleeding into the gastric lumen was observed. Contrast-enhanced computed tomography revealed stent migration from the MPD with active intraabdominal hemorrhage. The patient rapidly developed signs of peritonitis and hemodynamic instability, prompting an emergency laparotomy. Intraoperatively, the stent was found to have perforated the lesser and posterior gastric walls and was partially embedded in the pancreatic parenchyma. After removal of the stent, the gastric perforation was repaired, and hemostasis was achieved. A longitudinal pancreaticojejunostomy (Partington-Rochelle procedure) was performed to manage the injured and dilated pancreatic duct. The postoperative course was uneventful, with complete resolution of abdominal symptoms and no development of a pancreatic fistula. This case highlights the need for heightened awareness of potentially life-threatening EUS-PD-related complications. It also underscores the importance of timely surgical intervention and demonstrates that the Partington-Rochelle procedure can be a practical and effective option in emergency settings for managing ductal disruption caused by stent migration.