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Pancreatic pseudocyst
Classification and external resources
ICD-10 K86.3
ICD-9 577.2
DiseasesDB 9530
MedlinePlus 000272
eMedicine med/2674 radio/576
MeSH D010192

A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen.

Pancreatic pseudocysts are usually complications of pancreatitis,[1] although in children they frequently occur following abdominal trauma. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses. The prefix pseudo- (Greek for "false") distinguishes them from true cysts, which are lined by epithelium; pseudocysts are lined with granulation tissue.

Contents

Pathophysiology

Acute pancreatitis results amongst other things in the disruption of pancreatic parenchyma and the ductal system. This results in extravasation of pancreatic enzymes which in turn digest the adjoining tissues. This results in a collection of fluid containing pancreatic enzymes, hemolysed blood and necrotic debris around the pancreas. The lesser sac being a potential space, the fluid collects here preferentially. This is called an acute pancreatic collection. Some of these collections resolve on their own as the patient recovers from the acute episode. However, others become more organized and get walled-off within a thick wall of granulation tissue and fibrosis. This takes several weeks to occur and results in a pancreatic pseudocyst.

Investigations

The questions that need to be answered are:

  • where, how big and how many?
  • is there a communication with the pancreatic ductal system? Draining such a pseudocyst carries an increased risk of pancreatic fistula.

The most useful imaging tools are

  • Ultrasonography[2] - The role of ultrasonography in imaging the pancreas is limited by patient habitus, operator experience and the fact that the pancreas lies behind the stomach (and so a gas-filled stomach will obscure the pancreas).
  • Computerized tomography[3] - This is the gold standard for initial assessment and follow-up
  • Magnetic resonance cholangiopancreatography (MRCP) - to establish the relationship of the pseudocyst to the pancreatic ducts

Treatment

A small pseudocyst that is not causing any symptoms may be managed conservatively. However, a large proportion of them will need some form of treatment, The interventions available are:

  • Endoscopic trans-gastric drainage
  • Imaging guided percutaneous drainage
  • Laparoscopic/open cystogastrostomy
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Complications of pseudocyst

Complication of pancreatic pseudocyst include infection, haemorrhage, obstruction and rupture. For obstruction, it can cause compression in the GI tract from the stomach to colon, compression in urinary system, biliary system, and arteriovenous system.

References

  1. ^ Habashi S, Draganov PV (January 2009). "Pancreatic pseudocyst". World J. Gastroenterol. 15 (1): 38–47. PMID 19115466. PMC 2653285. http://www.wjgnet.com/1007-9327/15/38.asp.  
  2. ^ Aghdassi AA, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM (2006). "Pancreatic pseudocysts - when and how to treat?". HPB (Oxford) 8 (6): 432–41. doi:10.1080/13651820600748012. PMID 18333098.  
  3. ^ Aghdassi A, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM (March 2008). "Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis". Pancreas 36 (2): 105–12. doi:10.1097/MPA.0b013e31815a8887. PMID 18376299. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0885-3177&volume=36&issue=2&spage=105.  

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