Extraperitoneal Fluid Collection due to Chronic Pancreatitis
A 39-year-old man was referred to our hospital for the investigation of abdominal fluid collection. He had no symptoms before this admission, but he was pointed out to have alcoholic chronic pancreatitis with calcification and multiple pseudocysts by medical checkup. Laboratory data on admission showed high levels of C-reactive protein at 12.4 mg/dl (normal <0.3), a white blood cell count at 20 × 103/mm3 (normal 3.9–9.3 × 103), direct bilirubin at 2.2 mg/dl (normal 0.2–1.0), amylase at 185 IU/l (normal 36–120), low levels of red blood cells at 176 × 104/mm3 (normal 400–540 × 104) and hemoglobin at 6.7 g/dl (normal 12–16). Abdominal computed tomography demonstrated huge fluid collection pressing on the visceral organs, multiple pancreatic pseudocysts and pancreatic calcification (fig. ). The fluid showed a high level of amylase at 4,490 IU/l. Under the diagnosis of pancreatic ascites, at first conservative therapy and continuous fluid drainage was done, but reduction of discharge was not observed. Endoscopic pancreatic stent insertion was attempted but was unsuccessful. Under the diagnosis of pancreatic ascites caused by disruption of the pancreatic duct and rupture of a pancreatic pseudocyst, surgical treatment was attempted. At laparotomy, 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) (fig. ), but no fluid was found in the abdominal cavity. Extraperitoneal fluid collection due to chronic pancreatitis was diagnosed, and Frey procedure, cystojejunostomy, cholecystectomy and T tube placement in the common bile duct were performed. His postoperative course was uneventful and he has shown no recurrence of the fluid for 2 years.