Ascitis pancreática en paciente con pancreatitis aguda severa: un caso inusual

Background: Pancreatic ascites is an uncommon clinical entity resulting from the accumulation of pancreatic fluid in the peritoneal cavity. It is caused by the leakage from a pancreatic pseudocyst or injury to the pancreatic duct. Diagnosis is based on elevated amylase levels in ascitic fluid (greater than 1000 U/L) and protein levels above 2.5 g/dL. Chronic pancreatitis (83%), acute pancreatitis (8.6%), and trauma (3.6%) are the most common causes of pancreatic duct disruption. Case Summary: We report the case of a 59-year-old male patient referred to our institution for severe acute pancreatitis of biliary etiology, complicated by infected encapsulated necrosis. Necrosis extended through the left paracolic gutter to the pelvis and left inguinal region, with additional subcapsular hepatic fluid collections involving segments VI and VIII, requiring both endoscopic and percutaneous management. During clinical follow-up, the patient developed grade 3 ascites, for which he underwent two diagnostic and therapeutic paracenteses. Analysis of the fluid was consistent with pancreatic ascites. Conclusions: Patients with pancreatic ascites represent a small and heterogeneous population. Early detection is crucial due to the prognostic and therapeutic implications of this finding. Mild cases typically respond to medical management, while more severe cases require endoscopic treatment, with surgical intervention being rarely necessary.