title: Extraperitoneal Fluid Collection due to Chronic Pancreatitis.
abstract: A 39-year-old man was referred to our hospital for the investigation of abdominal fluid collection. He was pointed out to have alcoholic chronic pancreatitis. Laboratory data showed inflammation and slightly elevated serum direct bilirubin and amylase. An abdominal computed tomography demonstrated huge fluid collection, multiple pancreatic pseudocysts and pancreatic calcification. The fluid showed a high level of amylase at 4,490 IU/l. Under the diagnosis of pancreatic ascites, endoscopic pancreatic stent insertion was attempted but was unsuccessful, so surgical treatment (Frey procedure and cystojejunostomy) was performed. During the operation, a huge amount of fluid containing bile acid (amylase at 1,474 IU/l and bilirubin at 13.5 mg/dl) was found to exist in the extraperitoneal space (over the peritoneum), but no ascites was found. His postoperative course was uneventful and he shows no recurrence of the fluid. Pancreatic ascites is thought to result from the disruption of the main pancreatic duct, the rupture of a pancreatic pseudocyst, or possibly leakage from an unknown site. In our extremely rare case, the pancreatic pseudocyst penetrated into the hepatoduodenal ligament with communication to the common bile duct, and the fluid flowed into the round ligament of the liver and next into the extraperitoneal space.
authors.affiliation: Department of Surgery, Department of Internal Medicine, Kinki University Faculty of Medicine, Osakasayama, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Yasuda
authors.forename: Keiko
authors.initials: K
authors.lastname: Kamei
authors.forename: Mariko
authors.initials: M
authors.lastname: Araki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nakata
authors.forename: Hajime
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.forename: Takuya
authors.initials: T
authors.lastname: Nakai
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Takeyama
keywords: Chronic pancreatitis; Pancreatic ascites; Pseudocyst
references.citation: Ann Surg. 1973 May;177(5):538-46
references.pmid: 4704038
references.citation: J Gastroenterol Hepatol. 2006 Jun;21(6):1059-64
references.pmid: 16724995
references.citation: Surg Gynecol Obstet. 1982 Jun;154(6):845-8
references.pmid: 6177058
references.citation: AJR Am J Roentgenol. 1976 Oct;127(4):679-82
references.pmid: 970546
references.citation: Am J Gastroenterol. 1970 Feb;53(2):119-31
references.pmid: 5414267
references.citation: Int J Pancreatol. 1995 Apr;17(2):203-6
references.pmid: 7622943
references.citation: Hepatogastroenterology. 1993 Apr;40(2):150-4
references.pmid: 8509046
references.citation: Arch Surg. 1976 Apr;111(4):430-4
references.pmid: 1259581
references.citation: Medicine (Baltimore). 1974 May;53(3):183-95
references.pmid: 4825832
references.citation: Gastroenterology. 1978 Jan;74(1):134-40
references.pmid: 618422
references.citation: Ann Surg. 1976 Nov;184(5):587-93
references.pmid: 984927
references.citation: AMA Am J Dis Child. 1951 May;81(5):687-92
references.pmid: 14818413
references.citation: Dig Surg. 2006;23(4):250-4
references.pmid: 16943673
references.citation: Br J Radiol. 1998 Apr;71(844):450-6
references.pmid: 9659142
references.citation: Am J Gastroenterol. 1983 Mar;78(3):178-81
references.pmid: 6402923