Alcoholic male. Abdominal pain for 3-4 days.
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Gross amount of free fluid is noted in hepatorenal, splenorenal, perihepatic, perisplenic, both paracolic gutters, both iliac fossa and pelvic. Tiny echoes are present in ascites (compare with urinary bladder without echoes).
Visualized pancreas shows dilated main pancreatic duct - 4-5 mm.
No pneumoperitoneum is noted in epigastric region in supine position / on right side in left lateral decubitus position.
First ultrasound: gross ascites with echoes. Dilated main pancreatic duct was missed.
CT scan done later (images not available):
- fistula from main pancreatic duct communicating with ascites
- changes of chronic pancreatitis
- high density ascites.
Ascitic tap: high amylase.
Second review ultrasound: dilated main pancreatic duct seen.