Massive Pancreatic Ascites without Carcinoma Report of Three Cases

Abstract

Three cases of benign pancreatic ascites have been added to 94 cases reviewed from the literature. Common characteristics of this syndrome were chronic alcoholism, intermittent abdominal pain, nausea, vomiting and considerable weight loss which occurred despite fluid accumulation. Markedly elevated protein and amylase levels in the ascitic fluid, hyperamylasemia and hypoalbuminemia were the major diagnostic clues as to the pancreatic origin of ascites. Predominant pathological findings were chronic pancreatitis with or without pseudocysts, pancreatic duct disruption, lesions which were considered to be the major pathogenic factor besides lymphatic obstruction by leaking pancreatic juice into the peritoneal cavity. Early laparotomy for diagnosis and treatment is essential. ERP might be of great value in diagnosis.

Black Ascites: An interesting presentation of pancreatic duct leak

“…In a report of 96 cases of pancreatic ascites, the majority (n = 74) of cases described the ascitic fluid as amber-colored. [5] Other imaging that may be used to diagnose pancreatic ascites includes CT scan or ERCP to evaluate for pancreatitis or pseudocyst. ERCP is particularly beneficial as it is both diagnostic and therapeutic; after imaging, stent placement may occlude the disruption.…”

“…There have been reports of blunt abdominal trauma which led to pancreatic pseudocyst formation and pancreatic ascites, and even fewer reports of iatrogenic pancreatic ascites. [5] It has been reported that traumatic pancreatic ascites has a faster onset (several weeks to several months) than non-traumatic pancreatic ascites (several weeks to one year). [5] Iatrogenic pancreatic ascites is a rarely reported event.…”

“…[5] It has been reported that traumatic pancreatic ascites has a faster onset (several weeks to several months) than non-traumatic pancreatic ascites (several weeks to one year). [5] Iatrogenic pancreatic ascites is a rarely reported event. A literature search revealed one case report describing a patient who underwent endoscopic ultrasonography-guided fine needle aspiration for evaluation of a pancreatic neck mass with subsequent development of a pancreatic duct leak causing pancreatic ascites.…”