Successful Surgical Treatment for Intractable Pancreatic Ascites in Patients with Poor General Condition: Report of 3 Cases

Abstract

We report 3 cases of intractable pancreatic ascites successfully treated by surgery. Conservative treatment had been ineffective in all 3 patients and preoperatively their general condition was poor. Case 1: A 58-year-old man with alcoholic chronic pancreatitis and massive ascites was admitted to our hospital. Preoperative CT scan showed a pancreatic stone in the head of the pancreas with dilatation of the main pancreatic duct. He underwent the Frey operation. Case 2: A 50-year-old man with alcoholic acute pancreatitis and massive ascites was admitted to our hospital. A pancreatic fistula was diagnosed on the surface of the pancreatic neck by preoperative CT and intra-operative findings. He underwent the Bracey operation. Case 3: A 71-year-old man with alcoholic acute pancreatitis and massive ascites was admitted to our hospital. Preoperative endoscopic retrograde pancreatography had revealed a pancreatic leakage from a cyst in the head of the pancreas communicating with the main pancreatic duct. He underwent subtotal stomach-preserving pancreaticoduodenectomy. All patients had high preoperative inflammatory reactions, hypoalbuminemia, and anemia. Two patients developed respiratory complications and pancreatic fistulae, postoperatively. Because intractable pancreatic ascites leads to serious conditions in patients for whom conservative treatment has failed, surgical intervention should be considered without delay. It is very important for the choice of operative procedure to understand the pathological condition of the particular individual case.