This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Pancreas, Subject name: Surgery
[{'content': 'Pancreatic ascites. When to do surgery? \nSelect and explain. \nA. Symptomatic, B. Recurrent ascites following abdominal drainage, C. Not responding to medical therapy, D. Leak from the stented duct', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Ans. (d) Leak from the stented ductRef: Sabiston 20th ed; pg. 1531* Pancreatic ascites is nowadays a rare entity occurs due to complete disruption of the pancreatic duct leading to significant accumulation of fluid* Common causes include following acute pancreatitis with duct disruption, chronic pancreatitis with ductal obstruction with pseudocyst rupture and trauma causes.* Features include abdominal distension due to free fluid abdomen.* Diagnostic paracentesis shows elevated amylase and lipase levels suggesting pancreatic duct leak.* Initial management includes therapeutic paracentesis and endoscopic placement of pancreatic stent across the disruption.* Failure of this stenting, mandates surgical exploration which involves distal pancreatectomy and closure of the proximal stump.', 'role': 'assistant'}]