Not Your Typical Ascites, Pancreatic Ascites: A Case Report and Systematic Review of the Literature

Abstract

Background: Pancreatic ascites is a rare entity resulting from pancreatic duct leakage into peritoneum. The most common etiology is chronic pancreatitis or abdominal trauma. Case Presentation: A 23-year-old female with history of chronic pancreatitis secondary to alcohol abuse presented with acute on chronic epigastric pain with unintentional weight loss. Physical exam revealed epigastric and right upper quadrant tenderness without rebound or guarding. Labs were significant for low serum albumin and elevated lipase level. CT of abdomen without contrast demonstrated large volume ascites with normal looking pancreas. MRI of abdomen with intravenous contrast revealed two dilated tubules within the pancreatic neck communicating with the pancreatic duct, representing pancreatic fluid leakage into the peritoneal cavity. Paracentesis was performed yielding large volume of ascitic fluid with high amylase level, characteristic of pancreatic ascites. Patient was managed conservatively with bowel rest and octreotide. Conclusion: Pancreatic ascites is uncommon among the differential diagnosis of ascites. Diagnosis is suspected in a patient with chronic alcoholism or pancreatitis presenting with high amylase exudative ascites and/or pleural effusion. Though limited evidence, interventional therapy especially endoscopic procedure is recommended as initial treatment.