Pancreatic ascites. When to do surgery?
a) Symptomatic
b) Recurrent ascites following abdominal drainage
c) Not responding to medical therapy
d) Leak from the stented duct
Ans: D Reference: Sabiston 20th ed; pg. 1531 Explanation:
• Pancreatic ascites is nowadays a rare entity occurs due to complete disruption of the pancreatic duct leading to significant accumulation of fluid • Common causes include following acute pancreatitis with duct disruption, chronic pancreatitis with ductal obstruction with pseudocyst rupture and trauma causes. • Features include abdominal distension due to free fluid abdomen. • Diagnostic paracentesis shows elevated amylase and lipase levels suggesting pancreatic duct leak. • Initial management includes therapeutic paracentesis and endoscopic placement of pancreatic stent across the disruption. • Failure of this stenting, mandates surgical exploration which involves distal pancreatectomy and closure of the proximal stump.