International Journal of Surgery Case Reports · 6 authors, 2 centres
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A 63-year-old female presenting with acute abdominal pain was surgically explored for suspected perforated appendicitis, but intraoperative findings revealed chylous ascites secondary to acute pancreatitis with a normal appendix. Drainage and conservative postoperative management led to uneventful recovery.
This case report describes a 63-year-old female with a history of diabetes, cholelithiasis, and hepatitis B who presented with epigastric pain radiating to the right iliac fossa, nausea, vomiting, and abdominal distension. Clinical examination and ultrasound findings raised suspicion of acute perforated appendicitis, prompting open surgery. Intraoperatively, approximately 300 ml of brownish milky fluid was found in the right iliac fossa with a normal appendix; a bulky, inflamed pancreas with peripancreatic fat stranding was identified in the lesser sac. Amylase was elevated at 1615 U/l, and CT on postoperative day 3 confirmed acutely inflamed pancreas with peripancreatic fluid collection. Drains were placed, appendectomy was performed, and the patient recovered without postoperative complications. Limitations include the lack of intraoperative documentation, loss of fluid sample, and loss to follow-up at two weeks.
