Chylous ascites. A late complication of massive peripancreatic necrosis

A 43-yr-old female underwent a normal endoscopic retrograde cholangiopancreatography (ERCP) because of ill-defined abdominal discomfort. A life-threatening pancreatitis with massive peripancreatic necrosis ensued, necessitating multiple necrosectomies. A colonic fistula required a temporary colostomy. Thirty-three months after onset of pancreatitis, although seemingly stable, she developed a massive chylous ascites, the fluid of which had a lipid content of approx 8000 mg%. Her serum cholesterol and triglyceride levels remained normal. During her third postpancreatitis year, while under observation and without operative intervention, the ascites began to clear slowly, almost completely clearing over the ensuing 16 mo. No comparable syndrome has been detected in a literature review, although eight patients with chylous ascites, possibly associated with pancreatitis, were identified. Since the senior author, in a career in pancreatic surgery, had not previously encountered the problem and since its natural history in this patient revealed spontaneous improvement, its description seems worthwhile.