Pancreatic ascites. When to do surgery?
Symptomatic
Recurrent ascites following abdominal drainage
Not responding to medical therapy
Leak from the stented duct
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.
Pancreas