When to do surgery in pancreatic ascites?

PANCREATIC ASCITES: MANAGEMENT Pancreatic ascites occurs from a pancreatic duct disruption or from a leaking pseudocyst. High amylase levels are found in the ascitic fluid. Initial treatment: Non operative (elimination of enteral feeding, institution of nasogastric drainage, and administration of somatostatin) Repeat paracentesis may also be helpful. Roughly 50% to 60% of patients can be expected to respond to this treatment with resolution of pancreatic ascites within 2 to 3 weeks Persistent or recurrent ascites: Endoscopic or surgical treatment Endoscopic pancreatic sphincterotomy with or without placement of a transpapillary pancreatic duct stent . Resection (for leaks in the pancreatic tail) or internal Roux-en-Y drainage (for leaks in the head and neck region)