Pancreatic Ascites, When to do surgery
Pancreatic Ascites and Pancreaticopleural Fistulas Although very rare, complete disruption of the pancreatic duct can lead to significant accumulation of fluid. This condition should be suspected in patients who have an episode of AP, develop significant abdominal distention, and have free intra abdominal fluid. Diagnostic paracentesis typically demonstrates elevated amylase and lipase levels. Treatment consists of abdominal drainage combined with endoscopic placement of a pancreatic stent across the disruption. Failure of this therapy requires surgical treatment; it consists of distal resection and closure of the proximal stump. Ref: Sabiston 20th edition Pgno: 1531
Symptomatic
Recurrent ascites following abdominal drainage
Not responding to medical therapy
Leak from stented duct
G.I.T