eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2021-03-02 9 5 286 288 10.12691/ajmcr-9-5-6 AJMCR2021956 article Tian Li 1 Clara E. Wilson 1 Harry Zinn 2 Moro O. Salifu 2 Isabel M. McFarlane Isabel.McFarlane@downstate.edu 2 Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA 11203 Department of Radiology, State University of New York, Downstate Health Sciences University, Brooklyn, NY USA 11203 Background: Pancreatic ascites is a rare entity resulting from pancreatic duct leakage into peritoneum. The most common etiology is chronic pancreatitis or abdominal trauma. Case Presentation: A 23-year-old female with history of chronic pancreatitis secondary to alcohol abuse presented with acute on chronic epigastric pain with unintentional weight loss. Physical exam revealed epigastric and right upper quadrant tenderness without rebound or guarding. Labs were significant for low serum albumin and elevated lipase level. CT of abdomen without contrast demonstrated large volume ascites with normal looking pancreas. MRI of abdomen with intravenous contrast revealed two dilated tubules within the pancreatic neck communicating with the pancreatic duct, representing pancreatic fluid leakage into the peritoneal cavity. Paracentesis was performed yielding large volume of ascitic fluid with high amylase level, characteristic of pancreatic ascites. Patient was managed conservatively with bowel rest and octreotide. Conclusion: Pancreatic ascites is uncommon among the differential diagnosis of ascites. Diagnosis is suspected in a patient with chronic alcoholism or pancreatitis presenting with high amylase exudative ascites and/or pleural effusion. Though limited evidence, interventional therapy especially endoscopic procedure is recommended as initial treatment. http://pubs.sciepub.com/ajmcr/9/5/6/ajmcr-9-5-6.pdf chronic pancreatitis ascites pancreatic fistula endoscopic retrograde cholangiopancreatography