Diagnostic Complexity of Recurrent Ascites: Pancreatic Ascites Mimicking Portal Hypertension

Recurrent ascites is a common medical condition that can arise from various underlying causes. Although it is frequently associated with cirrhosis, recurrent ascites can have multisystemic and multifactorial etiologies. Pancreatic ascites is a relatively uncommon cause of ascites. We present the case of a 68-year-old man with a history of alcohol use disorder and necrotizing pancreatitis, which required multiple interventions. The patient developed recurrent ascites, necessitating repeated paracentesis. Initially, the workup suggested that the ascites was due to portal hypertension secondary to cirrhosis. However, a high index of suspicion prompted further investigation. Given the improvement in both pancreatitis and ascites over the following weeks, the dominant etiology was determined to be pancreatic ascites. This case highlights the importance of considering a broad differential diagnosis when evaluating recurrent ascites, particularly when the etiology is not immediately clear.