Small amounts of serosanguinous exudate in the abdominal cavity, clinically insignificant, have been a well recognized feature of acute pancreatitis. Massive, recurrent ascites as a complication of pancreatitis has not been reported. A case is presented which displayed recurrent ascites with normal liver function tests, liver biopsies, and no evidence of portal hypertension. Multiple sections, taken at surgery, were interpreted as fat necrosis of the small bowel and omentum consistent with recent pancreatitis. It is postulated that extensive blocking of lymphatic drainage and peritoneal irritation secondary to widespread fat necrosis is sufficient to explain the marked degree of ascites. In cases of massive ascites of obscure origin pancreatitis should be considered in the differential diagnosis.
Schmidt EH, Whitehead RP. Recurrent Ascites as an Unusual Complication of Chronic Pancreatitis. JAMA. 1962;180(7):533-535. doi:10.1001/jama.1962.03050200017005