Pancreatic ascites. When to do surgery?
Ans. (d) Leak from the stented ductRef: Sabiston 20th ed; pg. 1531* 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.
Symptomatic
Recurrent ascites following abdominal drainage
Not responding to medical therapy
Leak from the stented duct
Pancreas