CHYLOUS ASCITES - A LATE COMPLICATION OF MASSIVE PERIPANCREATIC NECROSIS

A 43-yr-old female underwent a normal endoscopic retrograde cholangiop ancreatography (ERCP) because of ill-defined abdominal discomfort. A l ife-threatening pancreatitis with massive peripancreatic necrosis ensu ed, necessitating multiple necrosectomies. A colonic fistula required a temporary colostomy. Thirty-three months after onset of the pancreat itis, although seemingly stable, she developed a massive chylous ascit es, the fluid of which had a lipid content of approx 8000 mg%. Her ser um cholesterol and triglyceride levels remained normal. During her thi rd postpancreatitis year, while under observation and without operativ e intervention, the ascites began to clear slowly, almost completely c learing over the ensuing 16 mo. No comparable syndrome has been detect ed in a literature review, although eight patients with chylous ascite s, possibly associated with pancreatitis, were identified. Since the s enior author, in a career in pancreatic surgery, had not previously en countered the problem and since its natural history in this patient re vealed spontaneous improvement, its description seems worthwhile.