Pancreatic ascites managed with a conservative approach: a case report

Imaging Diagnosis and Management of Fistulas in Pancreatitis

Pancreatic fistula is a highly morbid complication of pancreatitis. External pancreatic fistulas result when pancreatic secretions leak externally into the percutaneous drains or external wound (following surgery) due to the communication of the peripancreatic collection with the main pancreatic duct (MPD). Internal pancreatic fistulas include communication of the pancreatic duct (directly or via intervening collection) with the pleura, pericardium, mediastinum, peritoneal cavity, or gastrointestinal tract. Cross-sectional imaging plays an essential role in the management of pancreatic fistulas. With the help of multiplanar imaging, fistulous tracts can be delineated clearly. Thin computed tomography sections and magnetic resonance cholangiopancreatography images may demonstrate the communication between MPD and pancreatic fluid collections or body cavities. Endoscopic retrograde cholangiography (ERCP) is diagnostic as well as therapeutic. In this review, we discuss the imaging diagnosis and management of various types of pancreatic fistulas with the aim to sensitize radiologists to timely diagnosis of this critical complication of pancreatitis.

A Rare Case of Pancreatic Ascites Secondary to Chronic Pancreatitis

Pancreatic ascites refer to continuous leakage of pancreatic secretions in the peritoneum leading to accumulation of pancreatic fluid in the peritoneal cavity. Although literature on the incidence of pancreatic ascites and presenting signs and symptoms is scarce, it may be seen in patients with chronic alcoholic pancreatitis. Patients typically present with acute chronic pancreatitis and new-onset ascites, with or without abdominal pain. A diagnostic paracentesis is usually the first step to determine the etiology of the ascites. Mild cases may resolve with conservative management. Optimization of nutrition status is an important factor to reduce morbidity and mortality. More severe cases or cases refractory to conservative management may require endoscopic or surgical intervention. This case report describes a rare presentation of pancreatic ascites in a 35-year-old female.