Pancreatic Pseudocysts

Question 1

What is a pancreatic pseudocyst and what causes them to form?

Answer 1

A pancreatic pseudocyst is a collection of fluid around the pancreas covered by fibrous/granulation tissue.

The fluid in the cyst is usually pancreatic juice that has leaked out of a damaged pancreatic duct.

Pancreatic pseudocysts arise after acute pancreatitis or chronic pancreatitis. Usually arises several weeks after an acute attack (>10 days)

Question 2

Describe the typical presentation of a pancreatic pseudocyst?

Answer 2

Persistent abdominal pain, anorexia (cyst pressing on bowel), or abdominal mass after pancreatitis.

Jaundice or sepsis from an infected pseudocyst (rare)

Question 3

Describe the potential complications of an untreated pseudocyst?

Answer 3

Infection leading to abscess formation.

Psudocyst rupture causing peritonitis.

Pseudocyst erosion into the splenic aa causing life threatening bleeding.

Bowel obstruction.

Question 4

Describe the investigations you would use in a patient suspected of having a pancreatic pseudocyst?

Answer 4

Bloods as per pancreatitis. Amylase may be normal (usually still elevated from pancreatitis), LFTs may be abnormal if pressure on biliary tree

Imaging:
US may be used to visualize cystic fluid collections in and around the pancreas.

CT scanning is the gold standard.

Question 5

Describe the potential treatment of pancreatic pseudocysts?

Answer 5

Aim of treatment is to avoid complications. Approximately 10% of pseudocysts become infected.

Indications for drainage include the following:

• Complications
• Symptoms
• Concern about possible malignancy

Drainage can be done:

• Laparoscopically (if solid)
• Via ERCP (if fluid)