Successful Management of Pancreatic Ascites with both Conservative Management and Pancreatic Duct Stenting

Abstract

Pancreatic ascites is a rare complication and should be suspected in patients with chronic alcoholism and pancreatitis presenting with ascites. The etiology is likely from a pancreatic pseudocyst leakage or due to ductal disruption. Treatment is controversial but includes conservative medical therapy or endoscopic transpapillary pancreatic duct stenting or surgery. We present a case of pancreatic ascites in a patient with alcohol use and chronic pancreatitis. Patient received conservative therapy including octreotide. An endoscopic retrograde cholangiopancreatography was performed, which confirmed a pancreatic duct dehiscence with extravasation of the injected contrast. This was treated with placement of a stent. Patient improved clinically and symptomatically. This case report augments the existing data from two prior reported case series, and this modality of management should be actively pursued in such cases.

Comparison of clinical course of Acute Biliary and Non-Biliary Pancreatitis

“…29 These are mostly seen in the patients with traumatic, chronic and alcohol induced pancreatitis, cystic duplications of biliopancreatic ducts, ampullary stenosis or ductal lithiasis. 30,31 All together 4 patients developed pancreatic ascites in our study, one in biliary and 3 in non-biliary group. Incidence of local complications in our study is comparable with that of others in the literature.…”

Pancreatic ascites managed with a conservative approach: a case report

“…Pancreatic ascites refers to the massive accumulation of pancreatic fluid in the peritoneal cavity. The prevalence rate of pancreatic ascites is only 1%; it is more common in men than in women (male:female ratio 2:1) and between 20 and 50 years of age [8]. Ascites is commonly seen in patients with alcoholic liver disease and is usually a consequence of portal hypertension.…”

Endoscopic Retrograde Cholangiopancreatography Induced Pancreatic Ascites

“…Pancreatic ascites describes accumulation of fluid into the peritoneum that occurs in the setting of pancreatic duct dehiscence, a ruptured pancreatic pseudocyst, or an abscess with walled off necrosis and fistula formation with leakage of pancreatic contents into the peritoneum [1][2][3][4]. Approximately 95% of reported pancreatic ascites cases have occurred in the setting of chronic pancreatitis.…”

“…Pancreatic ascites typically occurs as a consequence of a pancreatic pseudocyst leakage or ductal injury leading to leakage of pancreatic secretions into the peritoneum [1,2]. While the incidence of pancreatic ascites remains unknown, it is thought to occur more frequently in males between the ages of 20 and 50 [3].…”

“…While the incidence of pancreatic ascites remains unknown, it is thought to occur more frequently in males between the ages of 20 and 50 [3]. Management is usually conservative, and includes holding oral feeds, providing parenteral nutrition, octreotide, and sometimes invasive procedures including endoscopic retrograde cholangiopancreatography (ERCP) and surgery [1,2]. Here, we present a rare case of ERCP induced pancreatic ascites with the aim to increase physician awareness of this condition.…”