Pancreatic ascites and pleural effusions.

Two cases of pancreatic ascites are presented and reviewed, together with 92 cases of internal pancreatic fistula reported in the recent literature. Alcohol abuse is the predominant aetiological factor, and chronic pancreatitis with an associated pseudocyst the most common pathological finding. The diagnosis depends on clinical suspicion and can be confirmed by the estimation of amylase and protein levels in the aspirated fluid. Medical treatment includes the aspiration of fluid accumulations, inhibition of pancreatic secretion, and nutritional augmentation. The use of pancreatography is recommended as a guide to the appropriate surgical procedure in patients who do not respond to medical therapy. Overall results indicate a cure rate of 77% and a mortality of 19%.