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Emerald effluent in severe pancreatitis: Acute PD as dual-action support?
Kamol Khositrangsikun1, Chalermpon Na Petvicharn1, Wongsakorn Boonkarn1
1Department of Internal Medicine, Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Thailand.
Summary
Emerald-green peritoneal fluid in a patient with severe pancreatitis indicated pancreatic leakage, not infection. Prompt peritoneal dialysis (PD) improved kidney function, but the patient later died from septic shock, highlighting the need for urgent evaluation of this rare finding.
Area of Science:
- Nephrology
- Gastroenterology
- Critical Care Medicine
Background:
- Gallstone pancreatitis can lead to severe complications including multiorgan failure and acute kidney injury.
- Acute peritoneal dialysis (PD) is a viable option for kidney support in hemodynamically stable patients with acute kidney injury.
- Unusual peritoneal fluid coloration can be a sign of serious intra-abdominal pathology.
Purpose of the Study:
- To report a rare case of emerald-green peritoneal effluent in a patient with gallstone pancreatitis.
- To investigate the cause of the unusual peritoneal fluid coloration.
- To evaluate the role of acute peritoneal dialysis in managing kidney support and intra-abdominal lavage in this context.
Main Methods:
- Bedside acute peritoneal dialysis (PD) was initiated for kidney support and intra-peritoneal lavage in a patient with severe gallstone pancreatitis, multiorgan failure, and acute kidney injury.
- Peritoneal effluent was analyzed for color, cell counts, and enzyme levels (amylase, lipase).
- Clinical parameters including acidosis, kidney function, and hemodynamic stability were monitored during PD.
Main Results:
- The peritoneal effluent was vividly emerald green, with sterile cultures but markedly elevated amylase and lipase levels, suggesting pancreatic leakage.
- PD led to a decline in effluent enzyme concentrations and cell counts, resolution of acidosis, and improved kidney function.
- Despite PD, the patient ultimately succumbed to septic shock.
Conclusions:
- Emerald-green peritoneal effluent is a rare clinical sign that may indicate severe intra-abdominal pathology, such as inflammatory pancreatic leakage.
- Acute peritoneal dialysis can provide effective kidney support and lavage in severe pancreatitis with acute kidney injury.
- Early and thorough evaluation is crucial when encountering unusual peritoneal fluid coloration to guide appropriate management, even if PD shows initial benefits.
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