Abstract
Pancreatic ascites created on a base of internal fistula is quite rare complication of chronic pancreatitis. Because of low frequency is the treatment still controversial.
The conservative treatment consists of the parenteral nutrition, application of somatostatin and its analogues; and or repeated paracentesis. The invasive treatment is endoscopical or surgical.
This paper describes a case of 53 years old patient diagnosed with ascites and fluidothorax. The laboratory tests showed leukocytosis and high level of CRP.
There was also found high level of amylase in ascitic fluid (327.1 μkat/L) by the diagnostic punction of ascites. The CT examination there were found indices of the chronic pankreatitis.
The ERCP examination proved large wirsungolithiasis and suspect fistula in the region of cauda of pancreas. The wirsungotomy was performed and stone was extracted; there was placed pancreatic stent.
However, the condition of patient did not improve, that is why the medication of somatostatin was started; paracentesis was also repeatedly performed. By repeated ERCP examination there was found a fistula in the region of head of pancreas, the fistula in the region of tail has not been proved yet.
Because of not sufficient retreat of ascites the surgical treatment was indicated. Nevertheless, during the pre-surgical treatment the condition of patient improved significantly and the patient was discharged.
The ERCP control did not prove any fistula of pancreas and so the stents were removed. The described case illustrates the successful treatment of the ascites of pancreas, where the endoscopical treatment was combined with the classical treatment including the administration of somatostatin.
Eventhough, the treatment algorithm of panreatic ascites is still controversial, majority of recently published works prefer invasive endoscopical or surgical treatment. It seems logical, from point of view of the invasivity ratio, that the endoscopical treatment should be placed before considered surgical treatment in the therapeutical algorithm.