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Abstract

Introduction: Pancreatic ascites is a rare complication of acute pancreatitis, particularly in pediatric patients. While chronic pancreatitis is a well-known cause of ascites, acute pancreatitis-induced ascites remains underrecognized. This case report explores a pediatric case of pancreatic ascites secondary to acute pancreatitis, emphasizing the diagnostic and therapeutic challenges.
Case presentation: A seven-year-old male presented with generalized abdominal distension and pain, along with a history of fever, vomiting, and loose stools. Initial investigations suggested eosinophilic ascites, but despite treatment, the patient showed no clinical improvement. Elevated amylase and lipase levels in both serum and ascitic fluid led to a revised diagnosis of acute necrotizing pancreatitis with bacterial peritonitis. Imaging revealed moderate acute interstitial pancreatitis with gross ascites. The patient underwent multiple interventions, including peritoneal catheterization, ERCP (endoscopic retrograde cholangiopancreatography) with stenting, and exploratory laparotomy, ultimately leading to the drainage of a large intraabdominal abscess. The patient recovered with supportive care and was discharged after 1.5 months
Conclusion: Acute pancreatitis-induced pancreatic ascites is rare in children, and its diagnosis requires a high index of suspicion. Imaging studies, elevated amylase, and lipase levels are crucial for identifying the pancreatic origin of ascites. Treatment focuses on supportive care, but severe cases may require invasive interventions such as drainage, ERCP, and surgery. This case underscores the importance of early recognition and intervention to improve outcomes in pediatric patients with pancreatic ascites.