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Pancreatic Ascites: Recognition and Management

Pancreatic Ascites: Recognition and Management Abstract • In a patient with chronic ascites, an abnormally raised ascitic fluid amylase concentration and a protein content above 2.5 gm/100 ml is diagnostic of pancreatic ascites. Thirty-one episodes in 26 patients treated between 1958 and 1975 have been analyzed. Twenty patients (65%) experienced abdominal pain and ten (32%) had concomitant pleural effusions roentgenographically. Although a leaking pancreatic pseudocyst was the cause of ascites in at least 21 episodes (70%), an abdominal mass could only be palpated in two of 26 patients. Roentgenographic series of the upper part of the gastrointestinal tract failed to demonstrate pancreatic pseudocyst in 7 of 21 episodes (33%). Endoscopic retrograde pancreatography is invaluable in delineating the pancreatic ductal system and, in conjunction with intraoperative pancreatography, makes a vital contribution to rational surgical therapy. Medical treatment or external drainage during 18 episodes resulted in death in four (22%) and recurrences of ascites or pancreatic pseudocyst in nine (64%). Since routine pancreatography followed by pancreatic resection or internal drainage has been instituted, mortality and recurrence have been reduced to zero. (Arch Surg 111:430-434, 1976) References 1. Donowitz M, Kerstein MD, Spiro HM: Pancreatic ascites . Medicine 53:183-195, 1974.Crossref 2. Sankaran S, Walt AJ: The natural and unnatural history of pancreatic pseudocysts . Br J Surg 62:37-44, 1975.Crossref 3. Kalwinsky D, Frittelli G, Oski FA: Pancreatitis presenting as unexplained ascites . Am J Dis Child 128:734-736, 1974. 4. Chang CH, Chen KM: Post traumatic pancreatic ascites . Am J Surg 122:129-131, 1971.Crossref 5. Sulamaa M, Viitanen I: Treatment of pancreatic rupture . Arch Dis Child 39:187-189, 1964.Crossref 6. Mullin GT, Caperton EM Jr, Crespin SR, et al: Arthritis and skin lesions resembling erythema nodosum in pancreatic disease . Ann Intern Med 68:75-87, 1968.Crossref 7. Cameron JL, Anderson RP, Zuidema GD: Pancreatic ascites . Surg Obstet Gynecol 125:328-332, 1967. 8. Cameron JL, Brawley RK, Bender HW, et al: Treatment of pancreatic ascites . Ann Surg 56:668-676, 1969.Crossref 9. Schindler SC, Schaeffer JW, Hull D, et al: Chronic pancreatic ascites . Gastroenterology 50:453-459, 1970. 10. Yancey AG, Ryan HF, Yancy PQ, et al: Pancreatic ascites producing abdominal distension . J Natl Med Assoc 62:431-434, 1970. 11. Bunao RM, Meyer KK: Pancreatitis with encephalomalacia and ascites . Am J Gastroenterol 55:145-151, 1971. 12. Barakat M, Goyal RK, Hersh T: Pancreatic ascites: Rupture of pancreatic duct in a patient with chronic pancreatitis . South Med J 65:1377-1379, 1972.Crossref 13. Smith RB, Warren WD, Rivard AA, et al: Pancreatic ascites: Diagnosis and management with particular reference to surgical techniques . Ann Surg 177:538-546, 1973.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Pancreatic Ascites: Recognition and Management

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Publisher
American Medical Association
Copyright
Copyright © 1976 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1976.01360220126021
Publisher site
See Article on Publisher Site

Abstract

Abstract • In a patient with chronic ascites, an abnormally raised ascitic fluid amylase concentration and a protein content above 2.5 gm/100 ml is diagnostic of pancreatic ascites. Thirty-one episodes in 26 patients treated between 1958 and 1975 have been analyzed. Twenty patients (65%) experienced abdominal pain and ten (32%) had concomitant pleural effusions roentgenographically. Although a leaking pancreatic pseudocyst was the cause of ascites in at least 21 episodes (70%), an abdominal mass could only be palpated in two of 26 patients. Roentgenographic series of the upper part of the gastrointestinal tract failed to demonstrate pancreatic pseudocyst in 7 of 21 episodes (33%). Endoscopic retrograde pancreatography is invaluable in delineating the pancreatic ductal system and, in conjunction with intraoperative pancreatography, makes a vital contribution to rational surgical therapy. Medical treatment or external drainage during 18 episodes resulted in death in four (22%) and recurrences of ascites or pancreatic pseudocyst in nine (64%). Since routine pancreatography followed by pancreatic resection or internal drainage has been instituted, mortality and recurrence have been reduced to zero. (Arch Surg 111:430-434, 1976) References 1. Donowitz M, Kerstein MD, Spiro HM: Pancreatic ascites . Medicine 53:183-195, 1974.Crossref 2. Sankaran S, Walt AJ: The natural and unnatural history of pancreatic pseudocysts . Br J Surg 62:37-44, 1975.Crossref 3. Kalwinsky D, Frittelli G, Oski FA: Pancreatitis presenting as unexplained ascites . Am J Dis Child 128:734-736, 1974. 4. Chang CH, Chen KM: Post traumatic pancreatic ascites . Am J Surg 122:129-131, 1971.Crossref 5. Sulamaa M, Viitanen I: Treatment of pancreatic rupture . Arch Dis Child 39:187-189, 1964.Crossref 6. Mullin GT, Caperton EM Jr, Crespin SR, et al: Arthritis and skin lesions resembling erythema nodosum in pancreatic disease . Ann Intern Med 68:75-87, 1968.Crossref 7. Cameron JL, Anderson RP, Zuidema GD: Pancreatic ascites . Surg Obstet Gynecol 125:328-332, 1967. 8. Cameron JL, Brawley RK, Bender HW, et al: Treatment of pancreatic ascites . Ann Surg 56:668-676, 1969.Crossref 9. Schindler SC, Schaeffer JW, Hull D, et al: Chronic pancreatic ascites . Gastroenterology 50:453-459, 1970. 10. Yancey AG, Ryan HF, Yancy PQ, et al: Pancreatic ascites producing abdominal distension . J Natl Med Assoc 62:431-434, 1970. 11. Bunao RM, Meyer KK: Pancreatitis with encephalomalacia and ascites . Am J Gastroenterol 55:145-151, 1971. 12. Barakat M, Goyal RK, Hersh T: Pancreatic ascites: Rupture of pancreatic duct in a patient with chronic pancreatitis . South Med J 65:1377-1379, 1972.Crossref 13. Smith RB, Warren WD, Rivard AA, et al: Pancreatic ascites: Diagnosis and management with particular reference to surgical techniques . Ann Surg 177:538-546, 1973.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1976

References