Chylous Ascites Secondary to Chronic Alcoholic Pancreatitis: Case Report and Review of the Literature

Chylous ascites is a rare condition characterized by accumulation of triglyceride-rich lymphatic fluid in the peritoneal cavity, most commonly associated with malignancy or infection, and is uncommon in pancreatitis. We report a 40-year-old man with heavy alcohol use who presented with acute-on-chronic pancreatitis and massive ascites. Initial ascitic fluid analysis showed markedly elevated amylase levels, suggesting pancreatic ascites. A main pancreatic duct stricture was treated with a fully covered self-expandable metal stent using an endoscopic ultrasound-guided rendezvous technique. On follow-up, pancreatic enzyme levels decreased, whereas triglyceride levels increased, consistent with newly developed chylous ascites. The patient subsequently developed milky pleural effusion with markedly elevated triglycerides, confirming concomitant chylothorax. With pancreatic duct decompression and conservative management, including a low-fat diet with medium-chain triglyceride supplementation, both ascites and pleural effusion gradually resolved. This case highlights that chylous ascites may develop during chronic pancreatitis and that addressing the underlying pancreatic pathology may facilitate resolution.