Endoscopic Retrograde Cholangiopancreatography Induced Pancreatic Ascites

Abstract

Pancreatic pathology is one of the causes of abdominal ascites. The estimated prevalence of pancreatic ascites is 3.5% in patients with chronic pancreatitis and it is mostly caused by pancreatic duct dehiscence in the setting of chronic pancreatitis. Other etiologies include pancreatic pseudocysts, trauma, severe acute pancreatitis and rupture to the pancreas. Management of this condition includes conservative management like holding feeds, total parenteral nutrition, administering somatostatin analogues or sometimes invasive procedures like endoscopic retrograde cholangiopancreatography (ERCP) and surgery. ERCP is an unusual cause of pancreatic ascites and only one other case report has linked an association between ERCP and the development of pancreatic ascites. Our case report contributes to this literature and aims to shed light on this under-reported cause of pancreatic ascites.

Keywords: endoscopy ercp; mrcp; pancreatic ascites.

Figure 1. CT abdomen/pelvis with IV contrast and arrows showing multiple loculated fluid collections concerning for pancreatic pseudocysts vs abscesses.

Smaller arrow is pointing to the pancreas while larger arrows are pointing to the fluid collections.