ReviewsMind the Gap—Disconnected Duct Syndrome A Review of Current Diagnostic and Management StrategiesHughes, Daniel Llwyd MRCS∗; Silva, Michael A. FRCS† Author Information From the ∗Department of Oncology, University of Oxford †Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom. Received for publication August 10, 2021; accepted October 4, 2022. Address correspondence to: Daniel Llwyd Hughes, MRCS, Department of Oncology, University of Oxford, Old Road Campus Research Bldg, Roosevelt Dr, Oxford, United Kingdom OX3 7DQ (e-mail: [email protected]). The authors declare no conflict of interest. Pancreas 51(8):p 911-915, September 2022. | DOI: 10.1097/MPA.0000000000002133 Buy Metrics Abstract Disconnected duct syndrome (DDS) is an adverse sequela of acute necrotizing pancreatitis in which there is disruption of the pancreatic duct leading to a failure to deliver pancreatic secretions into the duodenum. Its presentation may range from a persistent external pancreatic fistula to a treatment-resistant pancreatic pseudocyst. The diagnosis is often delayed in the acute setting if there is concurrent necrosis as management is often directed to the associated peripancreatic fluid collection. A combination of imaging modalities may be required to evaluate ductal anatomy. No definitive consensus has been achieved regarding the optimal treatment strategy for DDS, and there is a lack of published level I evidence on the topic. Treatment should be tailored to each individual patient, depending on the anatomy of ductal disruption, the presence of sepsis, the degree of physiological derangement, and the patients' performance status. Patients with DDS represent a specific cohort of patients with complex pancreatic disease that requires the input from a diverse multidisciplinary team to ensure that a good clinical outcome can be achieved. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.