SURGICAL-TREATMENT OF PANCREATIC ASCITES AND PANCREATIC PLEURAL EFFUSIONS

Background/Aims: Massive ascites and pleural effusions are uncommon bu t well-documented complications of chronic pancreatitis. The present s tudy reviews the results of surgical management of pancreatic ascites and pleural effusions of pancreatic origin. Patients and Materials: Fr om forty-nine patients with chronic pancreatitis presenting with ascit es and/or pleural effusion of pancreatic origin, 31 were surgically tr eated. Results: Nineteen had ascites only, ten pleural effusions and t wo presented with both conditions. Diagnosis of the internal pancreati c fistula was based on the findings of high amylase levels and elevate d albumin content of the peritoneal and pleural exudates. Failure of m edical therapy was the indication. of surgical treatment in all patien ts. Thirteen were submitted to internal pancreatic drainage, 17 to ext ernal drainage and one to distal pancreatic resection. Eight of 17 ext ernally drained patients were reoperated for intraperitoneal abscesses (2), infected pseudocyst (1), pain, recurrence (3) and pancreatic fis tula (2);whereas reoperation occurred in only one of the 13 patients s ubmitted to internal drainage (p < 0.05). Conclusions: Internal pancre atic drainage was the ideal surgical treatment for patients with pancr eatic ascites and/or pleural effusion that did not. respond to medical treatment. When this was not feasible external drainage teas successf ully used as an alternative to pancreatic resection.