Pancreatic Pseudocyst

Done by: Fahad Almalki

Objectives
Defenition. Aetiology. Locations of pseudocyst. Clinical features. Investigations. Treatment.

Definition
Encapsulated collection of pancreatic fluid after 4 weeks formed by inflammatory fibrosis (NOT epithelial lining).

Aetiology
1 in 10 after alcoholic pancreatitis; chronic alcoholic pancreatitis is #1 cause in U.S. Blunt injury of the abdomen.

Locations of peudocyst
1. Between stomach and transverse colon. 2. Between stomach and liver. 3. Behind or below the transverse colon.

Clinical feature
1. Tensely cystic mass in the epigastrium. 2. Dosent move with respiration because it is retroperitoneal in location. 3. It does not fall forwards 4. Percussion: resonant because of stomach or intestine anterior to it. 5. Transmitted pulsations from aorta can be felt.

Investigation
U/S, CT (good for multiple) show fluid collection; MRI/MRCP; ERCP (for treatment): contrast will fill cyst if communication with duct.

Large Pseudocyst

Multiple pseudocysts

complications
1. Infection. 2. Bleeding into cyst (most common cause of death). 3. Fistula. 4. Pancreatic ascites. 5. gastric outlet obstruction.

Treatment
Conservative line of treatment: Majority of the pseudocysts following acute pancreatitis resolve spontaneously within 3-4 weeks. Hence regular U/S is done to observe the pseudocyst.

Treatment
Indications of surgery: 1. Most agree that if pseudocyst is > 5 cm it should be drained (especially if symptomatic). 2. No response to conservative line of treatment.

Surgery
Surgical Drainage: 1. If adherent to posterior wall of stomach: cystogastrostomy. 2. If adherent to duodenum: cystoduodenostomy (rare). 3. If not adherent to either: RouxenY cystojejunostomy (drain into Roux limb of jejunum). 4. If in tail: resect tail with cyst.

ALWAYS

Biopsy cyst wall to rule out cystic neoplasia

Refrences
Hopkins General Surgery Manual. Manipal manual of surgery. http://www.radiologyassistant.nl SRBs manual of surgery. http://emedicine.medscape.com/