Pancreatic Pseudocyst

Background

• Pancreatic pseudocyst is a localized fluid collection in or on the pancreas that lacks an epithelial lining, but is surrounded by fibrous or granulation tissue. They usually contain amylase or other pancreatic enzymes and are connected with the pancreatic duct system directly or through pancreatic parenchyma.
• Pseudocysts are caused by disruptions in the pancreatic duct system as the result of increased pressure from obstruction or from necrosis related to pancreatitis. Increased pressure leads to extravasation of pancreatic secretions and collection of fluid, usually in a location clearly connected with the pancreatic duct.

Evaluation

• Pancreatic pseudocysts may be symptomatic or may be discovered incidentally during imaging.
• Typical symptoms include anorexia, tender abdomen or persistent abdominal pain, nausea, and vomiting.
• The diagnosis can be confirmed with imaging ( computed tomography or ultrasound) and analysis of cyst fluid.

Management

• Asymptomatic pancreatic pseudocysts resolve with only supportive medical care in many cases.
• Consider interventional pseudocyst drainage for patients with:
  • persistent symptoms (such as abdominal pain or fever)
  • infection
  • hemorrhage
  • gastric, duodenal, or biliary obstruction
  • pseudocyst growth on serial imaging
  • ascites
  • pleural effusion
  • compression of major vessels
• Interventional drainage techniques for pseudocyst include:
  • endoscopic - uses endoscope to create fistula or place stent into pseudocyst
  • percutaneous - drains pseudocyst into container external to the body
  • surgical - uses surgical techniques to place stent into the pseudocyst