Pancreatic Pseudocyst

Introduction

-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 

Diagnosis 

Labs: Persistent serum amylase elevation, leukocytosis 

Imaging: Transabdominal ultrasound, Contrat-enhanced CT Scan, MRI
Treatment 

-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 

Symptomatic pseudocysts: 

Excision: Most definitive treatment 

External Drainage: Percutaneous catheter drainage 

Internal Drainage: Cystojejunostomy, Cystogastrostomy, Cystoduodenostomy 

Prognosis 

-The recurrence rate for pancreatic pseudocyst is 10% 

-Complications: Infection, Rupture, Hemorrhage

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