Onyx and glue embolization of a remnant transplant pancreatic duct with a pancreaticocutaneous fistula

Pancreatic duct (PD) leaks are difficult to manage with limited guidance in the literature. This is a case report of a patient with a PD leak from a remnant transplant PD after surgical removal of the donor duodenum due to an iatrogenic intraoperative tear. After long-standing drain management for the PD leak with a pancreaticocutaneous fistula, Onyx and glue embolization of the PD was performed in two different sessions to treat the PD leak. However, a durable clinical response could not be achieved with persistent low-volume pancreatic leak. The procedures were also complicated by pancreatitis, worsening endocrine function, and delayed abscess formation. Caution should be exercised when embolization of PD is being considered.