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Extraperitoneal Fluid Collection due to Chronic Pancreatitis
Takeo Yasuda1, Keiko Kamei, Mariko Araki
1Department of Surgery, Department of Internal Medicine, Kinki University Faculty of Medicine, Osakasayama, Japan.
Case Reports in Gastroenterology
|September 11, 2013
Summary
This study presents a rare case of pancreatic ascites caused by a pseudocyst penetrating the hepatoduodenal ligament and communicating with the common bile duct. Surgical intervention led to a successful outcome with no recurrence of fluid collection.
Area of Science:
- Gastroenterology
- Abdominal Surgery
- Pancreatic Diseases
Background:
- Alcoholic chronic pancreatitis can lead to complications like pancreatic ascites.
- Pancreatic ascites typically results from pancreatic duct disruption or pseudocyst rupture.
Observation:
- A 39-year-old male with alcoholic chronic pancreatitis presented with abdominal fluid collection and multiple pancreatic pseudocysts.
- Computed tomography revealed a large fluid collection with high amylase levels, initially diagnosed as pancreatic ascites.
Findings:
- Endoscopic treatment was unsuccessful; surgical intervention (Frey procedure and cystojejunostomy) was performed.
- Intraoperatively, fluid rich in amylase and bilirubin was found in the extraperitoneal space, originating from a pseudocyst that had penetrated the hepatoduodenal ligament and communicated with the common bile duct.
Implications:
- This case highlights an extremely rare pathway for pancreatic fluid to enter the extraperitoneal space via the hepatoduodenal ligament and common bile duct.
- Successful surgical management of this complex presentation suggests the efficacy of surgical intervention in rare cases of pancreatic ascites.
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