A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES
Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presen...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Andrey Kriger [verfasserIn] David Gorin [verfasserIn] Ayrat R. Kaldarov [verfasserIn] Stanislav Berelavichus [verfasserIn] Gleb Galkin [verfasserIn] Valeriya Pletneva [verfasserIn] Grigoriy Karmazanovsky [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch ; Portugiesisch |
| Erschienen: |
2018 |
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| Schlagwörter: |
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| Übergeordnetes Werk: |
In: International Journal of Medical Reviews and Case Reports - International Sci Ink Press Ltd, 2018, 2(2018), 4 |
|---|---|
| Übergeordnetes Werk: |
volume:2 ; year:2018 ; number:4 |
| Links: |
Link aufrufen |
|---|
| DOI / URN: |
10.5455/IJMRCR.pancreatic-fistula |
|---|
| Katalog-ID: |
DOAJ005487404 |
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| 520 | |a Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. | ||
| 650 | 4 | |a pancreatogenic ascites | |
| 650 | 4 | |a pancreatic fistula | |
| 650 | 4 | |a internal pancreatic fistula | |
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10.5455/IJMRCR.pancreatic-fistula doi (DE-627)DOAJ005487404 (DE-599)DOAJfc2a8d533566446cb691c281678e3c33 DE-627 ger DE-627 rakwb eng por Andrey Kriger verfasserin aut A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. pancreatogenic ascites pancreatic fistula internal pancreatic fistula chronic pancreatitis Medicine R David Gorin verfasserin aut Ayrat R. Kaldarov verfasserin aut Stanislav Berelavichus verfasserin aut Gleb Galkin verfasserin aut Valeriya Pletneva verfasserin aut Grigoriy Karmazanovsky verfasserin aut In International Journal of Medical Reviews and Case Reports International Sci Ink Press Ltd, 2018 2(2018), 4 (DE-627)1760646792 25349821 nnns volume:2 year:2018 number:4 https://doi.org/10.5455/IJMRCR.pancreatic-fistula kostenfrei https://doaj.org/article/fc2a8d533566446cb691c281678e3c33 kostenfrei http://www.ejmanager.com/fulltextpdf.php?mno=299888 kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2018 4 |
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10.5455/IJMRCR.pancreatic-fistula doi (DE-627)DOAJ005487404 (DE-599)DOAJfc2a8d533566446cb691c281678e3c33 DE-627 ger DE-627 rakwb eng por Andrey Kriger verfasserin aut A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. pancreatogenic ascites pancreatic fistula internal pancreatic fistula chronic pancreatitis Medicine R David Gorin verfasserin aut Ayrat R. Kaldarov verfasserin aut Stanislav Berelavichus verfasserin aut Gleb Galkin verfasserin aut Valeriya Pletneva verfasserin aut Grigoriy Karmazanovsky verfasserin aut In International Journal of Medical Reviews and Case Reports International Sci Ink Press Ltd, 2018 2(2018), 4 (DE-627)1760646792 25349821 nnns volume:2 year:2018 number:4 https://doi.org/10.5455/IJMRCR.pancreatic-fistula kostenfrei https://doaj.org/article/fc2a8d533566446cb691c281678e3c33 kostenfrei http://www.ejmanager.com/fulltextpdf.php?mno=299888 kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2018 4 |
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10.5455/IJMRCR.pancreatic-fistula doi (DE-627)DOAJ005487404 (DE-599)DOAJfc2a8d533566446cb691c281678e3c33 DE-627 ger DE-627 rakwb eng por Andrey Kriger verfasserin aut A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. pancreatogenic ascites pancreatic fistula internal pancreatic fistula chronic pancreatitis Medicine R David Gorin verfasserin aut Ayrat R. Kaldarov verfasserin aut Stanislav Berelavichus verfasserin aut Gleb Galkin verfasserin aut Valeriya Pletneva verfasserin aut Grigoriy Karmazanovsky verfasserin aut In International Journal of Medical Reviews and Case Reports International Sci Ink Press Ltd, 2018 2(2018), 4 (DE-627)1760646792 25349821 nnns volume:2 year:2018 number:4 https://doi.org/10.5455/IJMRCR.pancreatic-fistula kostenfrei https://doaj.org/article/fc2a8d533566446cb691c281678e3c33 kostenfrei http://www.ejmanager.com/fulltextpdf.php?mno=299888 kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2018 4 |
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10.5455/IJMRCR.pancreatic-fistula doi (DE-627)DOAJ005487404 (DE-599)DOAJfc2a8d533566446cb691c281678e3c33 DE-627 ger DE-627 rakwb eng por Andrey Kriger verfasserin aut A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. pancreatogenic ascites pancreatic fistula internal pancreatic fistula chronic pancreatitis Medicine R David Gorin verfasserin aut Ayrat R. Kaldarov verfasserin aut Stanislav Berelavichus verfasserin aut Gleb Galkin verfasserin aut Valeriya Pletneva verfasserin aut Grigoriy Karmazanovsky verfasserin aut In International Journal of Medical Reviews and Case Reports International Sci Ink Press Ltd, 2018 2(2018), 4 (DE-627)1760646792 25349821 nnns volume:2 year:2018 number:4 https://doi.org/10.5455/IJMRCR.pancreatic-fistula kostenfrei https://doaj.org/article/fc2a8d533566446cb691c281678e3c33 kostenfrei http://www.ejmanager.com/fulltextpdf.php?mno=299888 kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2018 4 |
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10.5455/IJMRCR.pancreatic-fistula doi (DE-627)DOAJ005487404 (DE-599)DOAJfc2a8d533566446cb691c281678e3c33 DE-627 ger DE-627 rakwb eng por Andrey Kriger verfasserin aut A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. pancreatogenic ascites pancreatic fistula internal pancreatic fistula chronic pancreatitis Medicine R David Gorin verfasserin aut Ayrat R. Kaldarov verfasserin aut Stanislav Berelavichus verfasserin aut Gleb Galkin verfasserin aut Valeriya Pletneva verfasserin aut Grigoriy Karmazanovsky verfasserin aut In International Journal of Medical Reviews and Case Reports International Sci Ink Press Ltd, 2018 2(2018), 4 (DE-627)1760646792 25349821 nnns volume:2 year:2018 number:4 https://doi.org/10.5455/IJMRCR.pancreatic-fistula kostenfrei https://doaj.org/article/fc2a8d533566446cb691c281678e3c33 kostenfrei http://www.ejmanager.com/fulltextpdf.php?mno=299888 kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei https://doaj.org/toc/2534-9821 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ AR 2 2018 4 |
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Andrey Kriger misc pancreatogenic ascites misc pancreatic fistula misc internal pancreatic fistula misc chronic pancreatitis misc Medicine misc R A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES |
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A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES pancreatogenic ascites pancreatic fistula internal pancreatic fistula chronic pancreatitis |
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rare case of chronic pancreatitis complicated by internal pancreatic fistula and pancreatogenic ascites |
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A RARE CASE OF CHRONIC PANCREATITIS COMPLICATED BY INTERNAL PANCREATIC FISTULA AND PANCREATOGENIC ASCITES |
| abstract |
Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. |
| abstractGer |
Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. |
| abstract_unstemmed |
Objective: pancreatogenic ascites is rare complication of the chronic pancreatitis associated with a rupture in the ductal system and caused by internal pancreatic fistula. It can become as a result of the chronic pancreatitis, injury of the pancreas and stricture of the pancreatic duct. Case presentation: 40 years old male was admitted to our hospital suffered of surrounded epigastric pain, nausea, vomiting, enlargement of the abdomen, dyspnoea. Anamnesis showed that patient suffers of chronic calculous pancreatitis for 4 years, was hospitalized 8-9 times per year for conservative treatment. Patient was admitted to our clinic in medium severity condition. Laparocentesis with the fluid examination revealed amylase level 6007 U/L, protein 3.8 g/L. CT scan showed multiple calcifications in the pancreatic parenchyma, pancreatic duct dilation to 5 - 7 mm, large concrements (5-6 mm) in the pancreatic duct, postnecrotic cyst 34 mm diameter in the pancreatic head, smaller cyst 23 mm diameter in the pancreatic body from which, most likely, proceed pancreatic fistula. Patient was operated. The cystopancreatojejunostomy with dissection of the fistula was performed. Patient returned three months later with recurrent complaints of pain and increasing of the abdomen due to the fluid component. According to preoperative examinations (CT) it was seemed like the recurrence of internal pancreatic fistula. Amylase level of the fluid was 22 U/L, protein level 41 g/L. Nevertheless, considering the chronic calculous pancreatitis surgical treatment was performed: subtotal pancreatic head resection with reconstruction of the pancreatojejunoanastomosis. Conclusion: internal pancreatic fistula with the pancreatogenic ascites is a rare complication of chronic pancreatitis. In cases without any other significant changes (pseudocysts, pancreatic duct dilation, calculous) it can be treated by endoscopic stent placement. Surgical treatment is prior in complicated cases. Surgical approach not always has a positive result because of inflammatory infiltration. |
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