PANCREATIC ASCITES - A RARE COMPLICATION OF NECROTIZING PANCREATITIS - A CASE-REPORT AND REVIEW OF THE LITERATURE

We describe a young patient with a family history of hereditary pancre atitis who developed extensive pancreatic necrosis complicated by panc reatic ascites. Because of failure of medical management, he was succe ssfully treated with operative necrosectomy and primary wound closure over peripancreatic drains. A postoperative low-output pancreaticocuta neous fistula resolved with time. Pancreatic ascites, as a result of p ancreatic duct disruption, is more common in chronic rather than acute pancreatitis and is exceedingly uncommon in the context of necrotizin g pancreatitis. When it complicates the latter, treatment should be gu ided by the principles of management of necrotizing pancreatitis. Howe ver, when true pancreatic ascites persists, the pancreatic duct anatom y and site of leak should be defined with endoscopic retrograde pancre atography (ERP). Treatment options include endoscopic duct dilatation and stent placement (if a stricture exists proximal to the leak), onla y pancreaticojejunostomy, or distal pancreatectomy (especially if the leak is located in the distal pancreas or in an enterically isolated d istal pancreas).