Emerald effluent in severe pancreatitis: Acute PD as dual-action support?

A 50-year-old man with severe presumed gallstone pancreatitis, multiorgan failure, and oliguric stage 3 acute kidney injury underwent bedside acute peritoneal dialysis (PD) for haemodynamically tolerated kidney support and intra peritoneal lavage. Catheter insertion drained a large volume of ascites that rapidly became vivid emerald green. Cultures remained sterile, whereas effluent amylase (11,041 U/L) and lipase (50,750 U/L) were markedly elevated, favouring inflammatory pancreatic leakage over infectious peritonitis or biliary perforation. During PD, effluent enzyme concentrations and cell counts declined, acidosis resolved, and kidney function improved. The patient subsequently died of septic shock. Emerald-green peritoneal effluent is rare and warrants urgent evaluation for serious intra-abdominal pathology.