Kobori Toshimitsu, Suzuki Ginga, Nakamichi Yoshimi, Serizawa Hibiki, Yamamoto Saki
Critical Care Center, Toho University Omori Medical Center, Tokyo, JPN.
Cureus. 2025 Apr 22;17(4):e82807. doi: 10.7759/cureus.82807. eCollection 2025 Apr.
In acute pancreatitis, ascitic fluid is typically pale yellow and exudative due to inflammation. We report a rare case of black ascitic fluid associated with gallstone-induced severe acute pancreatitis in a 71-year-old man with no underlying disease. The patient initially presented to a local hospital with acute-onset abdominal pain. Abdominal computed tomography (CT) revealed a common bile duct stone, and he was diagnosed with acute cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction and endoscopic nasobiliary drainage (ENBD) was performed. On the following day, his abdominal pain worsened, and further evaluation revealed elevated pancreatic enzyme levels and peripancreatic inflammatory changes on CT. He was subsequently diagnosed with acute pancreatitis. Despite four days of treatment with fluid resuscitation and antibiotics, his condition deteriorated, and he was transferred to our facility on Day 0. Upon arrival, he was intubated and started on mechanical ventilation due to respiratory failure. Continuous hemodiafiltration (CHDF) was initiated on Day 1 for metabolic acidosis and worsening renal function. On Day 3, abdominal CT revealed newly developed ascites, and paracentesis was performed due to concern for increased intra-abdominal pressure. The ascitic fluid appeared black. Laboratory analysis revealed a mildly elevated total bilirubin level and markedly elevated amylase and lipase levels, consistent with pancreatic ascites. Despite drainage and intensive supportive care, the patient developed multiple organ dysfunction syndrome (MODS), including refractory shock, respiratory failure, and renal insufficiency. He died on Day 5 of hospitalization. This case highlights an extremely rare presentation of pancreatic ascites with black discoloration in the early phase of acute pancreatitis. The black color was most likely due to pancreatic duct disruption and enzyme-mediated hemorrhagic changes. To our knowledge, this is the first reported case of black pancreatic ascites secondary to acute pancreatitis. Awareness of this rare manifestation may aid in the timely recognition and management of similar cases in the future.
在急性胰腺炎中，由于炎症，腹水通常呈淡黄色且为渗出液。我们报告一例罕见的黑色腹水病例，该病例发生在一名无基础疾病的71岁男性身上，与胆结石引起的严重急性胰腺炎相关。患者最初因急性腹痛就诊于当地医院。腹部计算机断层扫描（CT）显示胆总管结石，他被诊断为急性胆管炎。进行了内镜逆行胰胆管造影（ERCP）取石及内镜鼻胆管引流（ENBD）。次日，他的腹痛加重，进一步检查发现胰酶水平升高，CT显示胰腺周围有炎症改变。随后他被诊断为急性胰腺炎。尽管进行了四天的液体复苏和抗生素治疗，他的病情仍恶化，于第0天被转至我们的机构。到达时，由于呼吸衰竭，他被插管并开始机械通气。第1天开始进行持续血液透析滤过（CHDF）以治疗代谢性酸中毒和肾功能恶化。第3天，腹部CT显示新出现腹水，因担心腹内压升高而进行了腹腔穿刺。腹水呈黑色。实验室分析显示总胆红素水平轻度升高，淀粉酶和脂肪酶水平显著升高，符合胰腺腹水表现。尽管进行了引流和强化支持治疗，患者仍发生了多器官功能障碍综合征（MODS），包括难治性休克、呼吸衰竭和肾功能不全。他于住院第5天死亡。该病例突出了急性胰腺炎早期胰腺腹水出现黑色这一极其罕见的表现。黑色很可能是由于胰管破裂和酶介导的出血性改变所致。据我们所知，这是首例报告的继发于急性胰腺炎的黑色胰腺腹水病例。认识到这种罕见表现可能有助于未来及时识别和处理类似病例。
