Fischer, mastery of surgery, 6 th edition cameron, current surgical therapy 10 th edition blumgarts surgery of the liver and biliary tract. The evaluation and management of pancreatic pseudocysts has changed dramatically. Traditionally, pancreatic pseudocysts have been drained because of the perceived risks ofcomplications including infection, rupture or haemorrhage. Between 1969 and 1987, 68 patients with pancreatic pseudocysts were treated. They are important both in terms of management and differentiation from other cystic processes or masses in this region. A pancreatic pseudocyst is a fluidfilled sac that forms in the abdomen comprised of pancreatic enzymes, blood, and necrotic dead tissue. Pancreatic pseudocysts are the most common late complication of acute pancreatitis, chronic pancreatitis, and pancreatic trauma.
Patients who are not medically fi t for surgery should not undergo further evaluation of incidentally found pancreatic cysts, irrespective of cyst size strong recommendation, low quality of evidence 5. A pseudocyst is usually rich in pancreatic enzymes and is most often sterile. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses. We have adopted a more conservativeapproach with drainage only for uncontrolled pain or gastric outlet obstruction. In our study, the resolution rate of pancreatic pseudocysts did not differ significantly between the surgical and the endoscopic groups 93.
This article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. Management of pancreatic pseudocysts and walledoff. The first description of a pancreatic pseudocyst pp was made in 1761 by morgagni. A pancreatic pseudocyst consists of an accumulation of amylaserich pancreatic fl uid caused by ductal disruption arising from limited pancreatic necrosis. Spontaneous resolution or cyst diminution was observed in 75% of the patients with acute pancreatitis and trauma, but in only 33% of. Management of a large bleeding pancreatic pseudocyst by embolization charaf tilfine, jawad tadili, amine benkabbou, salwa bouklata, nabil moatassim billah abstract introduction. See equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial, by varadarajulu s. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses and typically are complications of chronic pancreatitis. Diagnosis and management of pancreatic pseudocysts, pancreatic. See equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a. They should be observed with regular followup by ultrasound examination of the abdomen. Diagnosis and management of pancreatic pseudocysts. The management of pancreatic pseudocyst katherine a. There was a slight male predilection for developing a pancreatic pseudocyst, but this was not statistically significant p 0.
A national comparison of surgical versus percutaneous drainage of pancreatic pseudocysts. Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic and open pancreatic. Laparoscopic management of a pancreatic pseudocyst. Pancreatic pseudocysts do contain inflammatory pancreatic fluid particularly the digestive enzyme amylase. It has a lining of cells that separates it from the nearby tissue. Indications for drainage are pain, enlargement of cyst, and complications infection, hemorrhage, rupture, and. Pdf according to the atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation. Pancreatic pseudocyst develops in both acute and chronic pancreatitis. A pancreatic pseudocyst happens when the ducts in your pancreas get blocked because of disease or injury.
Pseudocysts during chronic calcifying pancreatitis ccp. Flowchart chart 2 specifying the management of incidental pancreatic cysts 1. An experience of management of pancreatic pseudocysts. Pdf management of pancreatic pseudocysts researchgate. A pancreatic pseudocyst is a type of cyst that it is not contained inside an enclosed sac of its own with an epithelium lining. Classification and management of pancreatic pseudocysts ncbi. This change has largely been driven by better natural history data and by an increasing focus on minimally invasive approaches, but has occurred in the absence of highquality comparative effectiveness data. Pancreatic pseudocysts arise mostly in patients with alcohol induced chronic pancreatitis causing various symptoms and complications. Pancreatic pseudocysts pps present a challenging problem for physicians dealing with pancreatic disorders. The median age at diagnosis of pancreatitis was similar between the 31 patients with a pancreatic pseudocyst and the other 101 patients without a pseudocyst table 1 and fig. The traditional management of pancreatic pseudocyst pp is surgical drainage.
A total of 2 patients were diagnosed with pancreatitis over the 15year period. Jun 14, 2018 a pancreatic pseudocyst is a collection of tissue and fluids that forms on your pancreas. Fortytwo patients were identified who had an eventual diagnosis of pancreatic pseudocyst and had an endoscopic ultrasoundguided fineneedle aspirate available. The old teaching that cysts more than 6 weeks old or 6 cm in size should be drained is no longer true. Nutritional management in acute and chronic pancreatitis pharmacotherapy selfassessment program, 5th edition184 is correlated with the incidence of systemic complications and the presence of pancreatic necrosis. Treatment of pancreatic necrosis the multimodal glasgow.
The classification of pancreatic cysts, the endoscopic and surgical techniques used to manage pancreatic fluid collections, and the efficacy and complications of these techniques are discussed separately. A pseudocyst isnt closed and doesnt have a lining of epithelial cells separating it. Pdf endoscopic management of pancreatic pseudocysts. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Both cysts and pseudocysts are collections of fluid. Management of pancreatic pseudocystsa retrospective. Disruption of the pancreatic duct is common in the presence of extensive necrosis, and although resolution is the norm, persistent fistulae can be a challenging management problem. Management of pancreatic pseudocysts edinburgh research.
The efficacy of endoscopic treatment of pancreatic pseudocysts. 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. Historically, they have been treated either conservatively or surgically, with acceptable rates of complications and recurrence. Read management of pancreatic pseudocysts, journal of the american college of surgeons on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. 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 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. Abstractthis article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts.
If not, or if it causes a lot of pain or other symptoms. Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. Pancreatic pseudocysts and walledoff pancreatic necrosis are often the result of acute pancreatitis. Adams, md, facs the fascination that pseudocysts hold for surgeons is beyond comprehension. Pdf management of pancreatic pseudocysts magnus janzon.
Pancreatic pseudocysts and walledoff pancreatic necrosis wopn. This case report describes a rare complication of an eusguided transgastric drainage of a pp secondary to a suboptimally. From 1987 to 1997, 33 patients were treated with either acute n 19 or chronic n. Read diagnosis and management of pancreatic pseudocysts. 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. Pseudocyst, acute pancreatitis, endoscopy, drainage. This classification system can guide the selection of optimal treatment for a pancreatic pseudocyst. Pseudo pancreatic cyst is a common complication of pancreatitis. Pancreatic pseudocysts vanderbilt university medical center. Surgical management of complications associated with percutaneous andor endoscopic management of pseudocyst of the pancreas. Two patients 6% had persistent chronic pain and one patient 3% had evidence of exocrine pancreatic insufficiency with malabsorption. The formation of a pseudocyst usually requires 4 or more weeks many clinicians state six. Management of pancreatic pseudocysts sciencedirect. Dec 11, 2017 a national comparison of surgical versus percutaneous drainage of pancreatic pseudocysts.
Often pseudocysts get better and go away on their own. Data sources include ibm watson micromedex updated 28 feb 2020, cerner multum updated 2 mar 2020. An experience of management of pancreatic pseudocysts 71 p j m h s vol. The lesions were classified into three groups, cysts secondary to acute pancreatitis, to chronic pancreatitis, and to trauma. Cureus the management of an intraperitoneal leak following. Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal trauma. Acute pancreatitis is an acute inflammatory process of the pancreas. If a pseudocyst is small and not causing serious symptoms, a doctor may want to. Some have suggested that pseudocysts associated with acute pancreatitis are more likely to contain inflamma tory fluid 21 than pancreatic juice, but there are.
Review of management options for pancreatic pseudocysts. Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal tra. Internal drainage by cystgastrostomy was performed in 1921, cystduodenostomy in 1928, and cystjejunostomy in 1931. A white paper of the acr incidental findings committee alec j. An endoscopic ultrasound eusguided transgastric endoscopic approach is preferred if there is favourable access to the pp. Pdf classification and management of pancreatic pseudocysts. Pdf management of pancreatic pseudocysts stig bengmark. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic. Management of pancreatic pseudocysts in pediatric oncology. This topic will discuss the overall approach to management of pancreatic pseudocysts and walledoff pancreatic necrosis wopn. 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. Therefore, being a minimally invasive technique, endoscopic drainage could be an appropriate alternative to surgery in the management of pancreatic pseudocysts. Pdf a clinical study of pancreatic pseudocyst and its.
It can be caused by injury or trauma to the pancreas but the most common cause of pancreatic pseudocysts. A study of clinical features and management of pseudocyst of pancreas dr. In 1875 ledentu performed percutaneous drainage of a posttraumatic pseudocyst and in 1882 bozeman removed a 10kg pseudocyst from a 41yearold patient. Karunakar reddy department of general surgery, kakatiya medical college, warangal, telangana state. Management of pancreatic pseudocysts and walledoff pancreatic necrosis view in chinese disrupt the pancreatic duct, leading to formation of a walledoff necrosis or a pancreatic pseudocyst. If a pseudocyst is small and not causing serious symptoms, a doctor may want to monitor it with periodic ct. Hemorrhage from a pancreatic pseudocyst is a rare and often fatal complication of pancreatic trauma and pancreatitis.
It can be caused by injury or trauma to the pancreas but the. A pseudocyst isnt closed and doesnt have a lining of epithelial cells separating it from the nearby tissue. Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery. Gastroscopic and ultrasoundguided percutaneous cystgastrostomy. Open surgical drainage to the stomach or a jejunal roux limb, the primary therapy.
Management of pancreatic pseudocysts is associated with considerable morbidity 15 25%. In addition, we have shown that surgical and endoscopic treatments are efficacious and safe in the management of pancreatic pseudocysts. Patients with asymptomatic cysts that are diagnosed as pseudocysts on initial imaging and. Management of pancreatic pseudocysts and walledoff pancreatic. Their management demands the cooperation of surgeons, radiologists and gastroenterologists. Mortality ranges from 3 percent in patients with interstitial edematous pancreatitis to 17 percent in patients who develop pancreatic necrosis. Pancreatic pseudocyst correspondence rajesh paramasivam department of medicine. Management of pancreatic pseudocysts in children by a. A pancreatic pseudocyst is an encapsulated collection of fluid with a welldefined inflammatory wall. Review of management options for pancreatic pseudocysts ncbi. Management of pancreatic pseudocysts in children sciencedirect.
If a pancreatic fistula persists once resolution of sepsis and any significant collection has been confirmed by ct, pancreatic duct stent insertion at ercp is the. Pancreatic pseudocysts continue to pose a diagnostic and therapeutic challenge. The management of pancreatic pseudocyst clinica cirurgica. Surgical internal drainage of pancreatic pseudocysts can be performed safely with low morbidity and mortality provided patients are carefully selected and their medical management is optimized. Classification and management of pancreatic pseudocysts. Pancreatic pseudocysts are common sequelae of acute pancreatitis or chronic pancreatitis, and the most common cystic lesion of the pancreas. Pancreatic pseudocysts are different from true pancreatic cysts. Metal stents in management of pancreatic pseudocyst and. Robert zollinger, md overview the pancreatic pseudocyst is a collection of pancreatic secretions contained within a fibrous sac comprised of chronic inflammatory.
Management of pancreatic pseudocysts, journal of the. Pancreatic pseudocyst is a welldefined fluid collection, but without solid components, which occurs 4 weeks after an interstitial or edematous pancreatitis episode. A pancreatic pseudocyst is defined as an amylaserich fluid collection enclosed by. It is an entity likely to either remain asymptomatic or develop devastating complications. Original article clinical practice management management of incidental pancreatic cysts. Metal stents in management of pancreatic pseudocyst and walled off necrosis rajesh paramasivam gastroenterology unit, department of medicine, university putra malaysia, malaysia received may 20th, 2015accepted july 30th, 2015 keywords endoscopy. Management of a recurrent pancreatic pseudocyst sages. Pdf treatment of pancreatic pseudocysts researchgate. A pancreatic pseudocyst is a collection of tissue and fluids that forms on your pancreas. The natural history is to resolve spontaneously in a period of 46 weeks in more than 85% of the time. The small risk of malignant transformation, the high risks of surgical treatment, and the lack of highquality prospective studies have led to contradictory recommendations for their immediate management and for their surveillance. In addition to the ranson criteria, the glasgow criteria are scored using a similar approach with only eight clinical criteria assessed. 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.
Jan 17, 2018 a pancreatic pseudocyst happens when the ducts in your pancreas get blocked because of disease or injury. Indications for drainage are pain, enlargement of cyst, and complications infection, hemorrhage, rupture, and obstruction. Management of a large bleeding pancreatic pseudocyst by. Instead, the pseudocyst forms within a cavity or space inside the pancreas and is surrounded by fibrous tissue.