Pancreatic ascites managed with a conservative approach: a case report
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(2020) 14:154
CASE REPORT
Open Access
Pancreatic ascites managed with a conservative approach: a case report Raju Bhandari1* , Rajan Chamlagain2, Saraswati Bhattarai2, Eric H. Tischler3, Rajesh Mandal1 and Ramesh Singh Bhandari1
Abstract Background: Pancreatic ascites refers to the massive accumulation of pancreatic fluid in the peritoneal cavity and is a rare entity. Chronic alcoholic pancreatitis is the most common cause. Ascites is commonly seen in patients with alcoholic liver disease and is usually a consequence of portal hypertension. Biliary pancreatitis, pancreatic trauma and cystic duplications of biliopancreatic ducts, ampullary stenosis, or ductal lithiasis are the remaining causes. Case presentation: A 53-year-old Chhetri man, a chronic alcoholic, presented with epigastric pain and abdominal distension. He had made several previous visits to a local hospital within the past 6 months for a similar presentation. Serum alkaline phosphatase 248 IU/L, serum amylase 1301 IU/L, and lipase 1311 IU/L were elevated while serum calcium was decreased (1.5 mmol/l). Ascitic fluid amylase was elevated (2801 IU/L). A computed tomography scan of his abdomen revealed features suggestive of acute-on-chronic pancreatitis. The case was managed with a conservative approach withholding oral feedings, starting total parenteral nutrition, paracentesis, octreotide, and pigtail drainage. Conclusion: Pancreatic ascites is a rare entity. Diagnosis is suspected with raised ascitic fluid amylase in the presence of pancreatic disease. Such cases can be managed by conservative approach or interventional approach. We managed this case through a conservative approach. Keywords: Pancreatitis, Ascites, Surgical, Medical, Case report
Background Massive ascites in a chronic alcoholic patient is usually attributed to hepatic cirrhosis [1]. Pancreatic ascites should be suspected in patients with chronic alcoholism and pancreatitis presenting with ascites [2]. The etiology is probably a pancreatic pseudocyst leakage or ductal disruption [3]. The diagnosis is based on demonstration of ascitic fluid amylase (> 1000 U/L). Chronic pancreatitis (83%), acute pancreatitis (8.6%), and trauma (3.6%) are common causes for ductal disruption. Medical treatment includes withholding oral feedings, total parenteral nutrition (TPN), paracentesis, and administering octreotide [4]. For those not responding to medical therapy, * Correspondence: [email protected] 1 Department of General and GI Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal Full list of author information is available at the end of the article
interventional therapy may be needed which includes endoscopic transpapillary pancreatic duct stenting or surgery which includes cystogastrostomy, cystenterostomy, pancreatic sphincterectomy, or partial pancreatic resection [5–7]. We present a case of massive ascites in a patient with chronic pancreatitis secondary to chronic alcohol use. The case was successfully managed with a combination of medical and interventional therapy.
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