Pleural or ascitic fluid should be sent for analysis. An elevated amylase level, usually > 1,000 IU/L, with protein levels over 3.0 g/dL is diagnostic. Serum amylase is often elevated as well, due to enzyme diffusion across the peritoneal or pleural surface. Contrast-enhanced computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) may also assist in diagnosis, with the latter an essential component of treatment. Types External An external<unk>  is an abnormal communication between the pancreas (actually pancreatic duct) and the exterior of the body via the abdominal wall. Loss of bicarbonate-rich pancreatic fluid via a<unk>  can result in a hyperchloraemic or normal anion gap metabolic acidosis. Loss of a small volume of fluid will not cause a problem but an acidosis is common if the volume of pancreatic fluid lost from the body is large. Internal First described by Smith (1953), and elaborated upon by Cameron et al. (1976), internal<unk> s can result in pancreatic ascites, mediastinital pseudocysts, enzymatic mediastinitis, or pancreatic pleural effusions, depending on the flow of pancreatic secretions from a disrupted pancreatic duct or leakage from a pseudocyst.
Pancreatic fistula
Pancreatic abscess
Pancreatic pseudocyst
Enterocutaneous fistula
Gastrojejunocolic fistula
Biliary fistula
Hemosuccus pancreaticus
Vesicointestinal fistula