నైరూప్య

Chronic pancreatitis with extra peritoneal fluid collection misleadingly presenting as ascites

AMd Noh MSF, Abdul Rashid AM, Norafida B, Mohd. Hazeman Z, Idris I & Suraini MS

A 30 year old male was admitted to our medical ward with recurrent abdominal distension. He had multiple admissions for therapeutic and diagnostic peritoneal tapping, but culture & cytology came back negative. He was initially treated as alcoholic chronic liver disease (CLD) Child-Pugh B. Despite having recurrent admissions and treated as decompensated alcoholic CLD with spontaneous bacterial peritonitis, his peritoneal fluid cultures were negative and medical therapy for CLD failed to improve symptoms. We proceeded with Computed Tomography Abdomen and showed a large collection of fluid in the extraperitoneum with mild ascites. Subsequently, pigtail catheter was inserted under ultrasound guidance to drain extraperitoneal fluid and biochemistry came back with high amylase level of 9043 U/L and total protein of 1.2 g/dL. As fluid amylase level >1000 U/L, it fulfills the criteria for chronic pancreatitis and he was managed conservatively with continuous fluid drainage. Patient improved gradually.