Pancreatic pseudocyst

Definition

A pancreatic pseudocyst is a collection of tissue, fluid, debris, pancreatic enzymes, and blood in the abdomen. It can develop after acute pancreatitis.

Causes, incidence, and risk factors

Pancreatic pseudocysts usually develop after an episode of severe, acute pancreatitis. They often happen when the pancreatic ducts are disrupted by inflammation that occurs during pancreatitis. Risk factors for a pancreatic pseudocyst are acute pancreatitis, abdominal trauma, and chronic pancreatitis.

Symptoms

• Abdominal mass
• Inability to eat
• Persistent abdominal pain, may radiate to the back

Signs and tests

The health care provider may palpate your abdomen to feel for a pseudocyst, which feels like a mass in the middle or left upper abdomen.

Tests that may help diagnose pancreatic pseudocyst include:

• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound

Treatment

Treatment depends on the size of the pseudocyst and whether it is causing symptoms. Many pseudocysts go away on their own. Those that remain longer than 6 weeks and are larger than 5 cm in diameter may require surgery.

Surgical treatments include:

• Percutaneous (through the skin) drainage using a needle, usually guided by a CT scan
• Endoscopic -assisted drainage: uses an endoscope (a tube containing a camera and a light) to locate the pseudocyst
• Surgical drainage of the pseudocyst into the stomach or small intestine

Expectations (prognosis)

The outcome is generally good with treatment.

Complications

• A pancreatic abscess can develop if the pseudocyst becomes infected
• Rupture of the pseudocyst can be a serious complication -- shock and hemorrhage may develop
• The pseudocyst may compress adjacent organs

Calling your health care provider

Call your health care provider if you develop persistent abdominal pain or signs of pancreatic abscess such as fever or chills.

Rupture of the cyst is an emergency situation! Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of bleeding or shock, such as:

• Decreased consciousness
• Fainting
• Rapid heartbeat
• Severe abdominal pain

Prevention

Prevention of pancreatic pseudocysts is directed at preventing pancreatitis. If pancreatitis is caused by gallstones, it is usually necessary to surgically remove the gall bladder (cholecystectomy). When pancreatitis occurs due to alcohol abuse, the patient must abstain from alcohol.

References