When to do surgery in pancreatic ascites?
PANCREATIC ASCITES: MANAGEMENT Pancreatic ascites occurs from a pancreatic duct disruption or from a leaking pseudocyst. High amylase levels are found in the ascitic fluid. Initial treatment: Non operative (elimination of enteral feeding, institution of nasogastric drainage, and administration of somatostatin) Repeat paracentesis may also be helpful. Roughly 50% to 60% of patients can be expected to respond to this treatment with resolution of pancreatic ascites within 2 to 3 weeks Persistent or recurrent ascites: Endoscopic or surgical treatment Endoscopic pancreatic sphincterotomy with or without placement of a transpapillary pancreatic duct stent . Resection (for leaks in the pancreatic tail) or internal Roux-en-Y drainage (for leaks in the head and neck region)
Pancreas
Symptomatic
Recurrent ascites following abdominal drainage
Not responding to medical therapy
Leak from the stented duct
Recurrent ascites following abdominal drainage