Therapeutic challenges of pancreatic ascites and the role of endoscopic pancreatic stenting

Abstract

Management of pancreatic ascites poses significant therapeutic challenges. Treatment usually consists of either conservative management or interventional therapy with little consensus between the two options. Conservative therapy is the most common initial treatment option but has high failure rates hence arguing for interventional therapy as a preferred primary treatment option. Endoscopic treatment is particularly appealing due to lower failure rates and mortality than conservative therapy or surgery. We describe a patient with recurrent pancreatic ascites who was successfully managed with endoscopic transpapillary stenting. This report contributes to the limited but growing literature on the management of pancreatic ascites.

Figure 1

CT of the abdomen with ascites (black arrow) and pancreatic pseudocysts (white arrows) with adjoining pancreatic tissue.

Figure 2

Endoscopic retrograde cholangiopancreatogram shows accumulation of contrast in cystic structures adjacent to the pancreas (white arrow) and free extravasation from the body of the pancreas (black arrow).