Pseudocyst treatment observation internal drainage ercpsphnicterotomy cyst ostomy external drainage complications of cysts infection and. Instead, the pseudocyst forms within a cavity or space inside the pancreas and is surrounded by fibrous tissue. Helpful criteria for distinguishing between pancreatic pseudocyst and abscess were signs of sepsis. A pancreatic pseudocyst is a fluidfilled sac that forms in the abdomen comprised of pancreatic enzymes, blood, and necrotic dead tissue. Currently several classification systems are in use that are based on the origin of the pseudocyst, their relation to pancreatic duct anatomy and a possible pseudocyst duct communication. The upper gastrointestinal series often demonstrates typical displacement of the distal. The pancreas is a compound racemose gland, which exocrine excretion of is represented by the pancreatic juice, an important digestive fluid, while the endocrine secretion consists of enzymes involved in sugar metabolism. Large cysts will displace adjacent abdominal viscera. Pancreatic pseudocyst might have the radiographic appearance of a mass with fluid density in the area of pancreas. Case 1 was a 60yearold man who was admitted to our hospital complaining of left lower abdominal discomfort.
Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal tra. Pancreatic pseudocysts account for approximately 75% of all. An acute pancreatic pseudocyst is made of pancreatic fluids with a wall of fibrous tissue or. This means that an acute pseudocyst may have been known for months. This includes external drainage, internal drainage, and excision. How should people with pancreatic pseudocysts be treated. Nonsurgical management of a ruptured posttraumatic pancreatic. Two cases of pancreatic cancer accompanied by pseudocyst are reported. Introduction this booklet is for anyone who has recently been diagnosed with. He was readmitted and a dynamic computerized tomography ct scan was performed which showed diffusely bulky pancreas measuring 2. An individualized diagnostic approach combining sound anamnesis, thorough clinical. Pancreatic abscess and pseudocyst jama surgery jama. Drainage of a cyst in the area of the pancreas a gland to the right of the stomach.
A case report of giant pancreatic pseudocyst following. It is important to note that, in the classification, the terms acute and chronic refer to the pancreatitis associated with the pseudocyst and not to the mode of symptomatology of the pseudocyst itself. In an effort to determine the incidence of multiple pseudocyst disease and establish the optimal approach to this problem, the records of 91 consecutive patients diagnosed during a 36month period. Management strategies for pancreatic pseudocysts ncbi nih. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses and typically are complications of chronic pancreatitis. Treatment methods for people with pancreatic pseudocysts.
Case summary 42 yr old male presented with complaints of abdominal. Pancreatitis can be local or diffuse and is classified as acute, chronic, inherited, necrotic, or hemorrhagic. We combine one case report with nine others published in the literature since 1980. A pancreatic pseudocyst is a collection of tissue and fluids that forms on your pancreas. Pancreatic pseudocysts do contain inflammatory pancreatic fluid particularly the digestive enzyme amylase.
Ct of the pancreas had pseudocysts, and anderson and. Case summary 42 yr old male presented with complaints of abdominal pain for 20 days more over epigastric to left hypochondrium ho vomiting no ho abdominal distension,fever,hematemesis,melena,trauma, constipation no ho urinary symptoms no ho loss of wtappetite. Pancreatic pseudocyst develops in both acute and chronic pancreatitis. Majority of the patients had history of alcohol abuse 47%. Finally, in elderly patients who present with a history suggestive of cancer of the body of the pancreas or with a. Pancreatic cysts are being diagnosed more frequently because of the increasing usage of imaging techniques. A study of clinical features and management of pseudocyst of pancreas dr. A pancreatic pseudocyst is a fluidfilled sac in the abdomen that arises from the pancreas. 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. Cect abdomen was more useful for details of pseudocyst. Pancreatic pseudocysts are a wellknown complication of acute or chronic pancreatitis, with a higher incidence in the latter. However, they can also occur in the setting of chronic pancreatitis, postoperatively, or after pancreatic trauma. A pancreatic pseudocyst is a sac of fluid on or near your pancreas.
There is a well defined cystic hypoattenuated, enhancing lesion noted superior to the body of pancreas, inferior to the greater curvature of stomach, anteroinferior to the spleen and anterior to the upper pole. Occasionally, pancreatitis is complicated by the formation of a fibrouswalled cavity. Usually there is a preceding history of alcoholism or pancreatitis. It produces chemicals called enzymes needed to digest food. Jun 14, 2018 a pancreatic pseudocyst is a collection of tissue and fluids that forms on your pancreas. Classification and management of pancreatic pseudocysts. Unlike true medical cysts, pancreatic pseudocysts lack a specific covering of cells called epitheliumwhich. They are important both in terms of management and differentiation from other cystic processes or masses in this region. The pancreas is an abdominal organ that secretes several digestive enzymes. The spontaneous resolution rate of pancreatic pseudocysts pps is 86%, and the serious complication rate is 39%.
Gi disease any of a circumscribed collection of pancreatic secretions surrounded by nonepithelial cell lined fibrous walls of granulation tissue. Apr 26, 2017 pancreatitis can be local or diffuse and is classified as acute, chronic, inherited, necrotic, or hemorrhagic. Apr 27, 2018 pancreatic cysts are being diagnosed more frequently because of the increasing usage of imaging techniques. Pseudo pancreatic cyst is a common complication of pancreatitis. We report here a case of blunt trauma to the pancreas complicated by the development ofa pseudocyst. Pancreatic pseudocysts belong to a large and heterogeneous group of cystic pancreatic lesions and represent a complication of acute or chronic pancreatitis.
Heres what you need to know about pseudocysts and their treatment. Pancreatic pseudocysts see the image below are best defined as localized fluid collections that are rich in amylase and other pancreatic enzymes, that have a nonepithelialized wall. Traumatic pseudocyst of the pancreas a case report. Diagnosis and management of pancreatic pseudocysts, pancreatic. Pancreatic pseudocysts are localized collections of pan creatic secretions. Fischer, mastery of surgery, 6 th edition cameron, current surgical therapy 10 th edition blumgarts surgery of the liver and biliary tract. It may also contain tissue from the pancreas, enzymes, and blood. Apr 01, 2001 a hemorrhagic pseudocyst is an uncommon indication for surgery. Other complications such as pseudocyst formation, pseudoaneurysm formation, or venous thrombosis, increase morbidity and mortality to a lesser degree. Not a true cyst because no epithelial lining painful, localized collections of pancreatic secretions that develop after pancreatitis acute or chronic, trauma, ductal calculi, obstructive neoplasms. Finally, in elderly patients who present with a history suggestive of cancer of the body of the pancreas or with a pseudocyst in the distal gland without a history of pancreatitis, presurgical documentation of a ductobstructing mass, probably malignant, should be sought. The chest roentgenogram reveals a retrocardiac mass in a patient with nonspecific upper abdominal and chest complaints. A pseudocyst is a cystic lesion that may appear as a cyst on scans, but lacks epithelial or endothelial cells.
It is an entity likely to either remain asymptomatic or develop devastating complications. The pancreas is often described as having a head, body and tail. More recently, novel hybrid and endoscopic techniques which combine pseudocyst irrigation and along with pancreatic necrosectomy have. The pancreas is an organ located behind the stomach.
Pancreatic abscess and pseudocyst jama surgery jama network. Pdf pancreatic pseudocysts pps present a challenging problem for physicians. This patient was a candidate for endoscopic transpapillary drainage to manage his pseudocyst. It can be caused by injury or trauma to the pancreas but the most common cause of pancreatic. A pseudocyst with the major diameter of 10 cm is termed as a giant cyst. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Unlike true medical cysts, pancreatic pseudocysts lack a specific covering of cells called epitheliumwhich can be viewed under a microscope. We report here a case of blunt trauma to the pancreas complicated. A pancreatic pseudocyst is a type of cyst that it is not contained inside an enclosed sac of its own with an epithelium lining. The extension of a pancreatic pseudocyst into the mediastinum is a difficult clinical and radiographic diagnosis.
A pancreatic pseudocyst is a kind of abnormal, fluidfilled sac found inside the pancreas. Itwas first reported in 1856 and since then there have been several of such cases. Radiographs will not distinguish pseudocyst from the inflammation pattern typical of acute pancreat. Pancreatitis is most commonly caused by alcohol abuse and gallstones. It is surrounded by several large and important organs and blood vessels. Pancreatic pseudocyst an overview sciencedirect topics. Surgical treatment of pancreatic pseudocysts sciencedirect. Management of pancreatic pseudocystsa retrospective. Most common site for pseudocyst was body and tail 24%. Pancreatic cancer an overview of diagnosis and treatment.
A case report of giant pancreatic pseudocyst following acute. It is important to note that, in the classification, the terms acute and chronic refer to the pancreatitis associated with the pseudocyst and not to the mode of. Despite being diagnosed easily, treatment exercise is still at crossroads whether in the form of internal or external drainage or endoscopic, laparoscopic, or open intervention with a good radiological guidance. Dec 11, 2017 pancreatic pseudocysts see the image below are best defined as localized fluid collections that are rich in amylase and other pancreatic enzymes, that have a nonepithelialized wall consisting of fibrous and granulation tissue, and that usually appear several weeks after the onset of pancreatitis. A hemorrhagic pseudocyst is an uncommon indication for surgery. The unilocular pseudocyst was located in the body of the pancreas in contact with the pancreatic duct. Development of huge pancreatic pseudocyst following.
Occasionally, pancreatitis is complicated by the formation of a fibrouswalled cavity filled with pancreatic enzymes, termed a pseudocyst. The formation of pancreatic pseudocysts and pseudoaneurysms of intestinal vessels are rare but. A less common cause or contributor is trauma, such as a blow to the abdomen. Most pancreatic pseudocysts occur as a consequence of acute pancreatitis. A study of clinical features and management of pseudocyst of. Pseudocysts may form in a number of places, including the pancreas, abdomen, adrenal gland, and eye. Arterial pseudoaneurysm within a pancreatic pseudocyst fulltext. It can be caused by injury or trauma to the pancreas but the most common cause of pancreatic pseudocysts. Not a true cyst because no epithelial lining painful, localized collections of pancreatic secretions that develop after pancreatitis acute or chronic, trauma, ductal calculi, obstructive.
Review of management options for pancreatic pseudocysts ncbi. Karunakar reddy department of general surgery, kakatiya medical college. Pseudocysts usually form as the result of a hard blow to your abdomen or an inflammation of the pancreas known as pancreatitis. Pdf can we predict outcome of pancreatic pseudocysts. Karunakar reddy department of general surgery, kakatiya medical college, warangal, telangana state. Drainage was the treatment of choice for a mature pseudocyst. Pancreatic pseudocysts a pancreatic pseudocyst is a fluidfilled sac that forms in the abdomen comprised of pancreatic enzymes, blood, and necrotic dead tissue. Abdominal pain was the presenting symptom 98% and abdominal tenderness was present in 62% of patients. Infection can occur, requiring antibiotics and further treatment. Pancreatitis inflammation of the pancreas alcohol abuse. Nausea, vomiting, normal serum amylase values, and clinical and roentgenographic evidence of epigastric or retrogastric masses were common findings in 19 patients with pseudocysts. Nausea, vomiting, normal serum amylase values, and clinical and roentgenographic evidence of epigastric or retrogastric masses were common findings in 19 patients with pseudocysts and eight with abscesses treated from 1969 through 1974. Although pancreatic pseudocyst may regress on its own and requires no further treatment, interventions are required in selected cases, particularly those complicated with infections, large size causing mass effect symptoms such as gastric outlet obstruction, bowel obstruction, hydronephrosis and biliary obstruction, diameter increasing in size. A cystic lesion, about 3 cm in diameter, was found in the pancreatic tail by ultrasonography us and computed tomography ct.
The patient was readmitted 72 hours after, with a new episode of epigastric pain accompanied by nausea and plenitude. The head of the pancreas is next to the duodenum the first part of the small intestines. The management of pancreatic pseudocyst katherine a. In this study, the authors explored the cytomorphologic features of pseudocyst of the pancreas and evaluated the role of alcian blue and mucicarmine stains in the cytologic evaluation of. Pseudocyst definition of pseudocyst by medical dictionary. Robert zollinger, md overview the pancreatic pseudocyst is a collection of pancreatic secretions contained within a fibrous sac comprised of chronic inflammatory. The chest roentgenogram reveals a retrocardiac mass in a patient with.
A gastroenterologist may drain the pseudocyst through the stomach by creating a small opening between the pseudocyst and the stomach, or by placing a stent into the pancreas during endoscopy. Pancreaticopleural and bronchial fistulae and associated. Pancreatic pseudocyst most common cystic lesions of the pancreas, accounting for 7580% of such masses location lesser peritoneal sac in proximity to the pancreas large pseudocysts. The most common cause of a pancreatic pseudocyst is inflammation of the pancreas, called pancreatitis. Dec 03, 2012 pancreatic pseudocyst most common cystic lesions of the pancreas, accounting for 7580% of such masses location lesser peritoneal sac in proximity to the pancreas large pseudocysts can extend into the paracolic gutters, pelvis, mediastinum, neck or scrotum may be loculated 4. The common bile duct carries a fluid called bile from the liver. Jun 19, 2015 for pancreatic pseudocysts with complications, symptoms, and increasing size, a classification system based on the individual characteristics of the cyst would offer physicians some guidance on therapeutic decision making. Pancreatic pseudocysts arise mostly in patients with alcohol induced chronic pancreatitis causing various symptoms and complications. The management of pancreatic pseudocyst clinica cirurgica. Management of a recurrent pancreatic pseudocyst sages. What increases my risk for a pancreatic pseudocyst.
Adams, md, facs the fascination that pseudocysts hold for surgeons is beyond comprehension. A study of clinical features and management of pseudocyst. Pancreatic pseudocysts are common sequelae of acute pancreatitis or chronic pancreatitis, and the most common cystic lesion of the pancreas. Risks of the drainage of a pseudocyst there are risks and complications with this procedure.