Black Ascites: An interesting presentation of pancreatic duct leak

Introduction: Common causes of ascites include liver cirrhosis, heart failure, and malignancy. Pancreatic etiology is lesscommon for ascites, but is most often a result of chronic pancreatitis secondary to alcoholic liver damage or pancreatic duct leak.Case description: The following case describes a patient with black-colored ascites secondary to pancreatic duct leak after totalcolectomy with ileorectal anastomosis. The colectomy was indicated by MYH-positive polyposis, and the there was no knownprior liver or pancreas disease. Management included pancreatic duct stent placement, and drains from the pancreatic tail.Discussion: Pancreatic etiology is rare among ascites diagnoses; this case is even rarer due to gross appearance of the asciticfluid and its iatrogenic cause.

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Pancreaticopleural fistula in a child with chronic pancreatitis harboring compound SPINK1 variants

BMC Gastroenterology ◽

10.1186/s12876-021-01842-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Teera Kijmassuwan ◽

Prapun Aanpreung ◽

Varayu Prachayakul ◽

Prakarn Tovichien

Keyword(s):

Chronic Pancreatitis ◽

Pleural Effusion ◽

Pancreatic Duct ◽

Imaging Modality ◽

Rare Complication ◽

Clinical Suspicion ◽

High Index ◽

Fistula Tract ◽

Radiological Imaging ◽

Pancreatic Duct Stent

Abstract Background Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis (CP) that requires a high index of clinical suspicion in the patient who presents with a pleural effusion. Visualizing the fistula tract from the pancreatic duct to the pleural space by radiological imaging provides confirmation of this complication. Case presentation A 9-year-old boy who presented with massive right pleural effusion secondary to PPF, a complication of CP from a genetic mutation involving two mutations of SPINK1. We successfully managed the case with by endoscopic pancreatic duct stent placement after failure of conservative treatment approaches. Conclusions PPF is a rare but serious complication of CP in all ages. The diagnosis of PPF in children requires a high index of clinical suspicion and should be considered in the differential diagnosis of massive pleural effusion where pancreatic pathology is present. A high level of pleural fluid amylase and the results from radiological imaging when the patients have symptoms play essential roles in the diagnosis of PPF. Currently, Magnetic resonance cholangiopancreatigraphy (MRCP) is the imaging modality of choice. Endoscopic therapy and surgery are treatment options for patients who do not respond to conservative therapy.

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Pancreatico-pericardial fistula as a complication of chronic pancreatitis

F1000Research ◽

10.12688/f1000research.3-31.v1 ◽

2014 ◽

Vol 3 ◽

pp. 31 ◽

Cited By ~ 3

Author(s):

Camille Anne Sommer ◽

C. Mel Wilcox

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Poor Prognosis ◽

Rare Complication ◽

Pericardial Fluid ◽

Endoscopic Retrograde ◽

Fluid Analysis ◽

Pancreatic Duct Stent ◽

Pancreatic Duct Stenting ◽

Duct Disruption

Pancreatico-pericardial fistula is an extremely rare complication of chronic pancreatitis. We present a case of a 58-year-old man who presented with syncope. Transthoracic echocardiogram revealed a pericardial effusion with tamponade physiology. Pericardiocentesis and pericardial fluid analysis demonstrated a lipase level of 2321 U/L. Subsequently, an endoscopic retrograde cholangiopancreatography (ERCP) was performed, confirming the presence of a pancreatico-pericardial fistula (PPF) from the distal body of the pancreas. A pancreatic duct stent was placed across the duct disruption on two separate occasions; however, despite stent placement, the patient continued to re-accumulate pericardial fluid and deteriorated. While rare, PPFs may complicate chronic pancreatitis, may not respond to pancreatic duct stenting and may portend a poor prognosis.

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Effect of Pancreatic Duct Stent Diameter on Hospitalization in Chronic Pancreatitis

Pancreas ◽

10.1097/mpa.0b013e3181b2bd45 ◽

2009 ◽

Vol 38 (7) ◽

pp. 728-731 ◽

Cited By ~ 13

Author(s):

Bryan G. Sauer ◽

Matthew J. Gurka ◽

Kristi Ellen ◽

Vanessa M. Shami ◽

Michel Kahaleh

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Pancreatic Duct Stent ◽

Stent Diameter

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Dysphagia Relieved by Endoscopic Transpapillary Pancreatic Duct Stent Placement!

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_58_17 ◽

2019 ◽

Vol 10 (01) ◽

pp. 053-055

Author(s):

Surinder Singh Rana ◽

Ravi Sharma ◽

Sobur Uddin Ahmed ◽

Sonali Guleria ◽

Rajesh Gupta

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Stent Placement ◽

Rare Case ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Pancreatic Duct Stent ◽

Pancreatic Duct Disruption ◽

Fluid Collections ◽

Duct Disruption

ABSTRACTPancreatic fluid collections are usually peripancreatic in location but can be found at various atypical locations such as the mediastinum. Mediastinal pseudocysts are very rare and are very unusual cause of dysphagia. Here, we report a rare case of mediastinal pseudocyst occuring because of pancreatic duct disruption due to chronic pancreatitis and presenting as dysphagia and successfully treated with endoscopic transpapillary stent placement.

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Severe hyponatremia in a COVID-19 patient

Case Reports in Internal Medicine ◽

10.5430/crim.v7n3p15 ◽

2020 ◽

Vol 7 (3) ◽

pp. 15

Author(s):

Waqar Haider Gaba ◽

Sara Al Hebsi ◽

Rania Abu Rahma

Keyword(s):

Heart Failure ◽

Liver Cirrhosis ◽

Adrenal Insufficiency ◽

Hospitalized Patients ◽

Severe Hyponatremia ◽

Diuretic Hormone ◽

Common Causes ◽

Electrolyte Abnormalities

Hyponatremia is one of the most common electrolyte abnormalities found in hospitalized patients. The diagnosis of the underlying cause of hyponatremia could be challenging. However, common causes include the syndrome of inappropriate anti-diuretic hormone (SIADH), diuretic use, polydipsia, adrenal insufficiency, hypovolemia, heart failure, and liver cirrhosis. The ongoing pandemic of coronavirus disease 2019 (COVID-19) can present with severe hyponatremia. The association of hyponatremia and COVID-19 infection has been described, though pathophysiology is not clear. Here we describe a case of a 61-year-old male who presented with severe hyponatremia (Na+ 100 mmol/L) thought to be secondary to SIADH associated with COVID-19 pneumonia.

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