Zerem E, Vila Š, Bajgorić S, Zerem D. Letter to the Editor: Ascites in acute pancreatitis: Prognostic considerations. World J Gastrointest Surg 2026; 18(5): 116880 [DOI: 10.4240/wjgs.v18.i5.116880]
Corresponding Author of This Article
Enver Zerem, MD, Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Bistrik 7, Sarajevo 71000, Bosnia and Herzegovina. zerem@anubih.ba
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Gastroenterology & Hepatology
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letter
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Zerem E, Vila Š, Bajgorić S, Zerem D. Letter to the Editor: Ascites in acute pancreatitis: Prognostic considerations. World J Gastrointest Surg 2026; 18(5): 116880 [DOI: 10.4240/wjgs.v18.i5.116880]
World J Gastrointest Surg. May 27, 2026; 18(5): 116880 Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.116880
Letter to the Editor: Ascites in acute pancreatitis: Prognostic considerations
Enver Zerem, Šeila Vila, Sanja Bajgorić, Dina Zerem
Enver Zerem, Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo 71000, Bosnia and Herzegovina
Šeila Vila, Sanja Bajgorić, Dina Zerem, Department of Health Studies, University Dzemal Bijedić Mostar, Mostar 88000, Bosnia and Herzegovina
Author contributions: Zerem E, Vila Š, Bajgorić S, and Zerem D contributed to the conception and design of the paper, writing the paper, and the final revision; All authors contributed equally to the writing of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Corresponding author: Enver Zerem, MD, Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Bistrik 7, Sarajevo 71000, Bosnia and Herzegovina. zerem@anubih.ba
Received: November 24, 2025 Revised: December 22, 2025 Accepted: February 10, 2026 Published online: May 27, 2026 Processing time: 185 Days and 14 Hours
Abstract
Ascites in acute pancreatitis (AP) has long been regarded as a nonspecific epiphenomenon of the inflammatory process. However, accumulating clinical and experimental evidence increasingly supports the view that ascites represents a clinically meaningful and readily accessible marker of disease severity. Building on our previously published study by Zerem et al, published in the recent issue of the World Journal of Gastroenterology on ascites in AP, this letter reframed ascites as an integrated pathophysiological signal that reflects both pancreatic structural disruption and systemic inflammatory activation. Early identification and dynamic monitoring of ascitic fluid may offer a valuable prognostic window into the evolving course of AP, particularly during the early phase of the disease when uncertainty regarding severity and outcome is greatest. Rather than proposing ascites as a replacement for established severity scoring systems, we argued that its presence, volume, and temporal evolution may complement existing risk stratification tools and enhance bedside clinical judgment. Finally, this article provided a conceptual framework to support future validation studies and to inform more nuanced, pathophysiology-driven clinical decision making in the management of AP.
Core Tip: Ascites in acute pancreatitis is a heterogeneous and dynamic clinical finding that may reflect the extent of pancreatic injury and the intensity of systemic inflammation. When detected early and interpreted cautiously, ascites can serve as a complementary prognostic signal that enhances bedside risk stratification without supplanting established scoring systems. Clear operational definitions and recognition of evidence limitations are essential to avoid over-interpretation.
