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Case Report
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| Unusual case of pancreatic ascites and pancreatic pleural effusion following endoscopic retrograde cholangiopancreatography | ||||||
| Rafael Alba Yunen1, King Soon Goh1, Ugoagha Chimbo-Osuagwu2, Sulaiman Azeez3 | ||||||
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1Resident, Department of Internal Medicine, Lincoln Medical and Mental Health, Bronx, New York, USA.
2Research Associate, Department of Internal Medicine, Lincoln Mental and Medical Health, Bronx, New York, USA. 3Chief Gastroenterology and Hepatology Department of Internal Medicine, Lincoln Medical and Mental Health, Bronx, New York. | ||||||
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| How to cite this article: |
| Yunen RA, Goh KS, Chimbo-Osuagwu U, Azeez S. Unusual case of pancreatic ascites and pancreatic pleural effusion following endoscopic retrograde cholangiopancreatography. International Journal of Case Reports and Images 2012;3(12):64–68. |
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Abstract
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Introduction:
Pancreatic fistula is the most common complication of pancreatic injury in the setting of blunt trauma and chronic alcoholic pancreatitis. Internal pancreatic fistulas (IPF) are most commonly cause by disruption of the pancreatic duct due to pancreatitis, and leakage from a pancreatic pseudocyst. We present a case of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatic leak complicated by pancreatic pleural effusions and pancreatic ascites.
Case Report: An 18-year-old Hispanic female was admitted with persistent right upper quadrant and epigastric pain, abdominal distention, constipation, leukocytosis and elevated pancreatic enzymes, with history of recent laporoscopic cholecystectomy due to cholelithiasis three months ago. She was diagnosed with choledocholithiasis, underwent successful ERCP, and was discharged home. After 24 hours of discharge, she developed symptoms of systemic inflammatory response syndrome and constipation. Computed tomography (CT) scan of abdomen and paracentesis revealed left sided ascites and plural effusion with high amylase content and no infection. She was diagnosed as suffering from pancreatic ascites and pancreatic pleural effusion following endoscopic retrograde cholangiopancreatography, secondary to internal pancreatic fistula. She received octreotide and a conservative approach to her condition, and had a good response to therapy. Conclusion: In our patient diagnosis was made by finding elevated amylase and protein content in the ascitic and pleural fluids plus CT scan revealed effusion and ascites and managed conservatively. The use of octreotide in such cases is established, and has been successful in our experience. | |
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Keywords:
ERCP, Internal pancreatic fistula, Pancreatitis, Pancreatic ascites, Plueral effusion
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Author Contributions
Rafael Alba Yunen – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published King Soon Goh – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Ugoagha Chimbo-Osuagwu – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Sulaiman Azeez – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© Rafael Alba Yunen et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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