Pancreatic Ascites Managed With a Conservative Approach

A Case Report

Raju Bhandari; Rajan Chamlagain; Saraswati Bhattarai; Eric H. Tischler; Rajesh Mandal; Ramesh Singh Bhandari

Disclosures

J Med Case Reports. 2020;14(154) 

In This Article

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, 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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