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Case Report



A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES

Andrey Kriger, David Gorin, Ayrat R. Kaldarov, Stanislav Berelavichus, Gleb Galkin, Valeriya Pletneva, Grigoriy Karmazanovsky.


Abstract

Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct.
Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis.
Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration.

Key words: pancreatogenic ascites, pancreatic fistula, internal pancreatic fistula, chronic pancreatitis.






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