Pseudocyst
Pseudocyst
- Acute pancreatitis is the most common cause (90%) followed by trauma (10%)
- Also develops after chronic pancreatitis
- 85% are located in the body or tail
- Collection of amylase-rich fluid enclosed in ‘a wall of fibrous or granulation tissue
- Formation requires 4 weeks or more from the onset of acute pancreatitis
- Often single, but multiple cysts may develop
- Fluid from a pseudocyst
- Low CEA level (CEA > 400ng/ml is suggestive of mucinous neoplasm)
- High amylase level
- Cytology reveals inflammatory cells
- Will resolve spontaneously in most instances
Pseudocysts that are less likely to resolve
- Thick walled
- Larger (>6cm)
- Longer duration (> 6 weeks)
- Following chronic pancreatitis
For pseudocyst causing symptoms:
- Preferred: Endoscopic Internal drainage (transgastric or transduodenal)
- External
- Percutaneous drainage – high recurrence and hence avoided
- Pseudocysts with complications – surgical management
Exam Question
- Most common cause of pancreatic pseudocyst is Pancreatitis (90%). The second most common cause is trauma (10%).
- The complication least likely to occur in a pseudocyst of the pancreas is Carcinomatous change
- Commonest complication of pancreatic pseudocyst ?
Infection
- “Other than pain, infection is the most common complication” – Maingot’s 10/e, p 1929
- Other complications are:
- Obstruction of GIT
- Hemorrhage
- Rupture
Pseudoanetoysm – splenic artery is most frequently involved.
- Percutaneous aspiration is preferred only in cases of infected cyst and abcesses, other wise internal drainage is the t/t of choice.
- Epigastric mass is the main symptom of pseudocyst.
- Increased level of amylase is usually elevated with pancreatic pseudocysts.
Don’t Forget to Solve all the previous Year Question asked on Pseudocyst