pancreatic pseudocyst
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Etiology
- complication of pancreatitis
- may be more common after acute pancreatitis than pancreatic cyst[1]
Pathology
- obstruction of pancreatic ducts results in pancreatic exocrine secretions overflowing into adjacent pancreatic tissue
- a fibrous wall forms to enclose the pancreatic secretions
- a pseudocyst is thus enclosed by fibrous tissue
- it contains
- inflammatory pancreatic fluid (digestive enzymes) or
- semisolid matter resulting from necrosis of pancreatic tissue digested by pancreatic secretions
- not true cysts (no epithelial lining) thus not neoplasm
- benign (not a malignant or premalignant lesion)
Clinical manifestations
- generally takes at least 4 weeks to form after episode of acute pancreatitis
- generally painless
- often resolves spontaneously
Laboratory
- CA 19-9 in serum may be a useful tumor marker
Diagnostic procedures
- endoscopic ultrasound if symptomatic or mucinous[1]
- rule out adenocarcinoma
- endoscopic cytology & biopsy
- percutaneous fine-needle biopsy/aspiration
- positive mucin stain &/or elevated CEA in aspirated fluid suggests mucinous adenocarcinoma
Radiology
- computed tomography
- septation, or a mass lesion is an indication for further evaluation
- magnetic resonance imaging[1]
Complications
- pseudocyst rupture or hemorrhage
- may occur without warning
- may be life-threatening
Differential diagnosis
- pancreatic cyst
- cystadenocarcinoma (generally painful)
- cystadenoma (generally painless)
- mucinous adenocarcinoma (malignant)
- walled-of pancreatic necrosis
Management
- most pseudocysts resolve without treatment
- when symptoms become persistent or complications emerge including infection, drainage is indicated[3]
- formerly, pseudocysts > 6 cm in size were drained[3]
- pseudocyst drainage
- endoscopic drainage
- percutaneous catheter drainage
- surgical drainage
- laparoscopy vs open surgery
- endoscopic drainage as effective as surgical drainage[4]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Barthet M et al, Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc 2008, 67:253 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18226686
- ↑ 3.0 3.1 3.2 Gumaste VV, Aron J. Pseudocyst management: endoscopic drainage and other emerging techniques. J Clin Gastroenterol. 2010 May-Jun;44(5):326-31 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20142757
- ↑ 4.0 4.1 Varadarajulu S et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013 Sep; 145:583 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23732774
- ↑ Tyberg A, Karia K, Gabr M et al Management of pancreatic fluid collections: A comprehensive review of the literature. World J Gastroenterol. 2016 Feb 21;22(7):2256-70. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26900288 Free PMC Article
- ↑ Cleveland Clinic: Pancreatic Cysts and Pseudocysts http://my.clevelandclinic.org/disorders/pancreatitis/hic-pancreatic-cysts-and-pseudocysts.aspx