Outcome of pancreatic ascites in patients with tropical calcific pancreatitis managed using a uniform treatment protocol.
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Date
2009-05
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Abstract
Pancreatic ascites or internal pancreatic fistula is a known complication of chronic pancreatitis. This condition is associated with considerable morbidity and mortality. The
management approach of pancreatic ascites in tropical calcific
pancreatitis is infrequently reported owing to the low
incidence of this condition. Between December 2005 and
June 2007, 11 patients with pancreatic ascites with tropical
calcific pancreatitis (male:female 7:4, mean age 29.5 [14.2]
years) were treated. A retrospective analysis of patients who
underwent endotherapy and surgery for this condition based
on an institutional protocol was performed. The end point
was resolution of pancreatic ascites and relief of symptoms.
All patients had pancreatic ascites, and one patient also
had pancreatic pleural effusion. Endoscopic transpapillary
stenting was possible in nine patients (81 ). Identification
of site of leak and placement of an endoscopic stent across
the PD disruption was possible in five (45 ) patients. All
these patients had relief of ascites. Mean number of endotherapy
sessions required before control of ascites was 1.8.
Among the remaining four (36.6 ) patients who had ERCP,
placement of stent across the leak was unsuccessful; however
stenting helped stabilize the general condition and nutritional
status. These four patients and two patients who failed ERP
underwent lateral pancreatojejunostomy surgery. Morbidity
was observed in three patients who underwent surgery and
one patient died due to sepsis and hemorrhage. All patients
who had surgical drainage had complete relief of ascites and
symptoms. In patients with pancreatic ascites in tropical
calcific pancreatitis endotherapy and transpapillary stenting
helps in resolution of ascites in nearly half of the patients. In
the remaining patients preliminary conservative management followed by surgical pancreatic ductal drainage provides good relief of symptoms.
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Keywords
Diabetes mellitus, Pancreatic endotherapy, Steatorrhea
Citation
Kurumboor Prakash, Varma Deepak, Rajan Mahendra, Kamlesh Naduthottam Palanisami, Paulose Roshin, Narayanan Ramesh Ganesh, Philip Mathew. Outcome of pancreatic ascites in patients with tropical calcific pancreatitis managed using a uniform treatment protocol. Indian Journal of Gastroenterology. 2009 May-Jun; 28(3): 102-106.