-Pancreatic pseudocysts are encapsulated collections of pancreatic fluid with high enzyme concentrations that arise from the pancreas.
-They are surrounded by nonepitheliazed wall of granulation tissue and fibrosis.
-They are usually located either within or adjacent to the pancreas in the lesser sac.
-Many occur as complications of severe acute pancreatitis
-Pseudocysts develop in about 10% of cases of acute pancreatitis, 30% of patients with chronic pancreatitis
Symptoms and Signs
-Failure to recover from acute pancreatitis
-a palpable tender mass in the epigastrium
-Abdominal pain, fever, weight loss, tenderness, jaundice
-they may become secondarily infected and become abscesses
-they can erode into visceral arteries and cause pseudoaneurysms
Labs: Persistent serum amylase elevation, leukocytosis
Imaging: Transabdominal ultrasound, Contrat-enhanced CT Scan, MRI
-Rule out Cystic neoplasms
Asymptomatic pseudocysts: expectant management, Spontaneous resolution occurs in 50% of cases; Supportive care includes nasogastric feeding, proton pump inhibitors, somatostatin receptor agonists
Excision: Most definitive treatment
External Drainage: Percutaneous catheter drainage
Internal Drainage: Cystojejunostomy, Cystogastrostomy, Cystoduodenostomy
-The recurrence rate for pancreatic pseudocyst is 10%
-Complications: Infection, Rupture, Hemorrhage