Pancreatic pseudocyst

Definition

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

Causes, incidence, and risk factors

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

Symptoms

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

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 ultrasound
• Abdominal MRI

Treatment

Treatment depends upon the size of the pseudocyst and whether it is causing symptoms. Many pseudocysts go away on their own. Pseudocysts must be allowed to mature for 6-8 weeks before surgery can be performed.

Surgical methods include the following:

• Percutaneous drainage using a needle, usually under radiological (CT scan) guidance
• 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

• Rupture of the pseudocyst can be a serious complication -- shock and hemorrhage may develop.
• A pancreatic abscess can develop if the pseudocyst becomes infected.
• 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 symptoms occur that may indicate the onset of bleeding and shock, such as the following:

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

Prevention

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

Illustrations

Digestive system

Endocrine glands

Pancreatic pseudocyst, CT scan

Pancreas

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