Diagnostic Complexity of Recurrent Ascites: Pancreatic Ascites Mimicking Portal Hypertension

TL;DR

This paper discusses a case where pancreatic ascites was mistaken for portal hypertension, emphasizing the need for thorough differential diagnosis in patients with recurrent ascites.

Contribution

The novelty lies in highlighting the diagnostic challenge of pancreatic ascites mimicking portal hypertension in a patient with a complex medical history.

Findings

The patient's ascites was initially attributed to portal hypertension but was later determined to be pancreatic ascites.

Improvement in pancreatitis and ascites over time supported the diagnosis of pancreatic ascites.

The case underscores the importance of a broad differential diagnosis in recurrent ascites.

Abstract

Recurrent ascites is a common medical condition that can arise from various underlying causes. Although it is frequently associated with cirrhosis, recurrent ascites can have multisystemic and multifactorial etiologies. Pancreatic ascites is a relatively uncommon cause of ascites. We present the case of a 68-year-old man with a history of alcohol use disorder and necrotizing pancreatitis, which required multiple interventions. The patient developed recurrent ascites, necessitating repeated paracentesis. Initially, the workup suggested that the ascites was due to portal hypertension secondary to cirrhosis. However, a high index of suspicion prompted further investigation. Given the improvement in both pancreatitis and ascites over the following weeks, the dominant etiology was determined to be pancreatic ascites. This case highlights the importance of considering a broad differential diagnosis when evaluating recurrent ascites, particularly when the etiology is not immediately clear.

Figures