A Case of Pancreatic Ascites and Pleural Effusion: Confirmation of a Pancreatic Duct Contrast Leakage Using Computed Tomography after Endoscopic Retrograde Cholangiopancreatography

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A seventy-two year old Japanese man with chronic alcoholism was admitted with increasing epigastric pain and abdominal fullness. He gave a history of bouts of epigastric pain radiating to the back for the past year. At admission, abdominal ultrasonography and computed tomography (CT) demonstrated massive ascites and a pseudocyst in the pancreatic body. A chest X-ray showed bilateral pleural effusion, and the level of amylase was elevated in the serum, urine, ascitic fluid and pleural effusion. First, the patient was treated with nothing by mouth but with intravenous hyperalimentation, however, no improvement was noted after 2 weeks. Then, the patient underwent endoscopic retrograde cholangiopancreatography (ERCP) and abdominal CT after ERCP. They showed irregular dilatation of the pancreatic main duct and branch, and an extravasation of contrast media from the pancreatic duct into the peritoneal cavity, after which the patient underwent surgery. Because no fistula was found during surgery, drainages were retained into the pseudocyst and peritoneal cavity. Due to marked elevation of amylase and protein levels in ascitic fluid and pleural effusion and findings from ERCP and CT after ERCP, pancreatic ascites and pleural effusion was diagnosed. The diagnosis of chronic pancreatitis is due to his history, laboratory data, and irregular dilatation of the pancreatic duct on ERCP. After surgery, his clinical status improved rapidly. We thus described a case of pancreaticoperitoneal fistula demonstrated by CT scan subsequent to ERCP which was treated successfully by surgery.
長崎大学の論文

A Case of Pancreatic Ascites and Pleural Effusion: Confirmation of a Pancreatic Duct Contrast Leakage Using Computed Tomography after Endoscopic Retrograde Cholangiopancreatography

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