Diagnostic difficulties in the differentiation of pancreatic pseudocyst and cystic pancreatic neoplasm can lead to misdiagnosis and inappropriate treatment, since clinical symptoms. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses and typically are complications of chronic pancreatitis. Subsequently, it has become apparent that ppc may develop but still undergo spontaneous. Nonsurgical management of a ruptured posttraumatic pancreatic. Endoscopic and percutaneous drainage techniques have become refined and universally available. Single or multiple fluid collections that look like cysts on pancreatic imaging are often observed during acute pancreatitis. The pancreas may be divided into five major regions the head, neck, body, tail and uncinate process figure 6. A pancreatic pseudocyst is a fluidfilled sac that forms in the abdomen comprised of pancreatic enzymes, blood, and necrotic dead tissue. We describe the challenges experienced during endoscopic transmural drainage in a low resource setting and the methods used to overcome these barriers. In humans, pancreatic inflammatory pseudocyst formation results from acute or chronic pancreatitis. The role of surgery in pancreatic pseudocysts has changed for several reasons.
The fluid in the cyst is usually pancreatic juice that has leaked out of a damaged pancreatic duct. The ct and mr confirmed a pseudocyst in the same location with an 11. A 68yearold male with the remote history of alcohol abuse presented with abdominal pain secondary to acute pancreatitis. Dec 11, 2017 single or multiple fluid collections that look like cysts on pancreatic imaging are often observed during acute pancreatitis. Pseudo pancreatic cyst is a common complication of pancreatitis. 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. A pancreatic pseudocyst is a collection of fluid around the pancreas.
Prior to the advent of ultrasonography us assessment of the cyst was difficult. Adams, md, facs the fascination that pseudocysts hold for surgeons is beyond comprehension. Endoscopic ultrasound drainage of pancreatic pseudocyst. Between april 1992 and july 1995 endosonography was performed in 32 patients, referred for endoscopic pseudocyst drainage, to. Pancreatic pseudocyst which persists beyond 6 weeks and which develops a thick wall determined radiologically needs surgical. For example, use of the imaging term phlegmon is discouraged because it does not correlate with the presence of either infection or. Pancreatitis can be local or diffuse and is classified as acute, chronic, inherited, necrotic, or hemorrhagic. Pancreatic pseudocyst ppc is an uncommon condition in childhood and is almost always associated with blunt abdominal trauma. Acute peripancreatic fluid collection radiology reference.
The atlanta system attempted to standard ize the terminology of acute pancreatitis. Case report open access pancreatic cancer accompanied. Pancreatic pseudocysts gastrointestinal medbullets step 1. 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. The endoscopic approach was used, the anastomosis was occluded with gastric debris, we used a double pigtail stent to communicate the cyst and stomach. Sensitivity, however, was poor with only 1229 mucinous cysts being detected by staining. Pancreatic pseudocysts are a wellknown complication of acute or chronic pancreatitis, with a higher incidence in the latter. The first computed tomography ct of the abdomen showed acute necrotizing pancreatitis. Pancreatic cyst fluid harbors a unique microbiome microbiome. A study of clinical features and management of pseudocyst of. The sphincter of oddi is a dynamic structure that relaxes and contracts to change the dimensions of the ampulla of vater.
However, a pseudocyst is defined as a fluid collection without clinical signs of infection. Pancreatic pseudocyst most common cystic lesions of the pancreas, accounting for 7580% of such masses location one third of cysts are in the head region and two third in the region of body of pancreas lesser peritoneal sac in proximity to the pancreas large pseudocysts can extend into the paracolic gutters, pelvis, mediastinum may be loculated may be single or multiple. Carroll, md, mph, university of rochester school of medicine, rochester, new york brian herrick, md, university of california at. Histologically, it is defined as a collection of pancreatic juice enclosed by fibrous or granulation tissue with inflammatory cell infiltration as in this case. An unusual presentation of pancreatic pseudocyst mimicking.
A study of clinical features and management of pseudocyst of pancreas dr. Fischer, mastery of surgery, 6 th edition cameron, current surgical therapy 10 th edition blumgarts surgery of the liver and biliary tract. Although surgical drainage of pancreatic pseudocysts has been superseded by less invasive options, the requirement for specialized equipment, technical expertise, and consumables limits the options available in low resource settings. A 54 year old male patient was referred to gastroenterology. Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal tra. Pancreatic pseudocysts, endoscopic transpapillary drainage, acute pancreatitis.
Combined laparoscopic cholecystectomy and drainage of. Pancreatic pseudocyst located in the liver is an exceptional event, commonly following acute pancreatitis, rising in older male, involving the left lobe of the liver and treated by percutaneous. Case report open access pancreatic cancer accompanied by a. The pancreatic pseudocyst is a pancreatic fluid collection which classically develops due to acute or chronic pancreatitis. True pseudocyst formation is extremely rare in ectopic pancreas. A study of clinical features and management of pseudocyst. Blunt abdominal trauma is the major cause of abdominal injury in children.
Currently several classification systems are in use that are based on the origin of the pseudocyst, their relation to pancreatic duct anatomy and a. Cyst in the uncinate process in a normal pancreas with slight dilatation of the pancreatic duct cysts and pseudocysts. Endoscopic management of pancreatic pseudocyst and necrosis. Apr 18, 20 a contrastenhanced computed tomography scan of the abdomen showed a welldefined pseudocyst of size 11. The national institute for health and clinical excellence nice has prepared this overview to help members of the interventional procedures advisory committee ipac make recommendations about the safety and efficacy of an interventional procedure. Laparoscopic pancreatic pseudocyst drainage orange county. This procedure is performed with a minimally invasive method that utilizes a laparoscope a small video camera and small instruments inserted through small incisions. Diagnostic difficulties in the differentiation of pancreatic pseudocyst and cystic pancreatic neoplasm can lead to misdiagnosis and inappropriate treatment, since clinical symptoms, preoperative. Case report open access pancreatic cancer accompanied by a moderatesized pseudocyst with extrapancreatic growth yu ohkura1, kazunari sasaki1, masamichi matsuda1, masaji hashimoto1, takeshi fujii2 and goro watanabe1 abstract background. The pancreas develops in two parts from the endoderm of the primitive duodenum dorsal part.
Aug 17, 2009 bleeding from pancreatic pseudocyst s rupture into adjacent organs is a rare, but potentially fatal, complication of chronic pancreatitis requiring quick management. A second, relatively small study, noted a sensitivity of mucicarmine staining for detecting mcn at 56% 59 lesions 33. Bleeding from pancreatic pseudocysts rupture into adjacent organs is a rare, but potentially fatal, complication of chronic pancreatitis requiring quick management. Surgical treatment of pancreatic pseudocysts sciencedirect. Surgical procedures of laparoscopic pancreatic pseudocyst drainage on during laparoscopic pancreatic pseudocyst drainage, fluid from symptomatic pseudocysts is removed. In spite of their rarity, cystic neoplasms of the pancreas are characterized by existing or potential malignancy that cannot be ignored during decisive process with regard to the choice of treatment. Sep 18, 2009 pancreatic pseudocysts often arise as a complication of acute or chronic pancreatitis.
This means that an acute pseudocyst may have been known for months in one patient, whereas a chronic pseudocyst in another patient may have been documented for only a week or two. The absence of necrosis differentiates apfcs from acute necrotic collections anc, that is, apfcs occur in interstitial edematous pancreatitis, not in. Management of a recurrent pancreatic pseudocyst sages. Review of management options for pancreatic pseudocysts ncbi. Pdf according to the atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation. Massive upper gastrointestinal bleeding from a pancreatic. 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. Karunakar reddy department of general surgery, kakatiya medical college, warangal, telangana state.
Measurement of the amylase content of the cystic fluid will not differentiate between retention cyst and pseudocyst as. We combine one case report with nine others published in the literature since 1980. A second, relatively small study, noted a sensitivity of mucicarmine staining for detecting mcn at. Additional disease within the pancreas is rare, unlike adult experience. Pancreatic stumps oversewn with nonabsorbable sutures are associated with a higher rate of fistula and abscess than. Cureus one of the largest pancreatic pseudocysts in the. Endosonographic imaging of pancreatic pseudocysts before. Apr 01, 2001 the role of surgery in pancreatic pseudocysts has changed for several reasons. 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. One day prior to scheduled surgical drainage, he developed melena, and the abdominal lump resolved. Pancreatic pseudocysts often arise as a complication of acute or chronic pancreatitis. The prevalence of pancreatic pseudocysts in chronic pancreatitis is 20% to 40%. 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. The management of pancreatic pseudocyst katherine a.
Diagnosis and management of blunt pancreatic trauma. Acute peripancreatic fluid collections apfc are an early complication of acute pancreatitis that usually develop in the first four weeks. A contrastenhanced computed tomography scan of the abdomen showed a welldefined pseudocyst of size 11. Endoscopic transmural drainage of pancreatic pseudocysts. A conservative wait and watch policy is best suited for acute pancreatic pseudocyst as majority of these resolve spontaneously. The prevalence of pancreatic pseudocysts in acute pancreatitis has been reported to range from 6% to 18. Update on pancreatic cyst fluid analysis 3 annals of gastroenterology 25 muc staining has been reported 32. Pancreatic cancer accompanied by a moderatesized pseudocyst with extrapancreatic growth is extremely rare. The management of pancreatic pseudocyst the surgeon.
Exocrine function 12 liters alkaline fluid elevated bicarb otherwise isotonic 20 enzymes or precursors amylase, lipase, trypsinogen, pepsinogen. More recently, novel hybrid and endoscopic techniques which combine pseudocyst irrigation and along with pancreatic necrosectomy have. Currently several classification systems are in use that are based on the origin of the pseudocyst, their relation to pancreatic duct anatomy and a possible pseudocystduct communication. Occasionally, pancreatitis is complicated by the formation of a fibrouswalled cavity filled with pancreatic enzymes, termed a pseudocyst. Bacteria may or may not be present in a pseudocyst culture. Because of increasing sensitivity of imaging modalities and improvements in technology providing enhanced therapeutic abilities, the questions of when and whether drainage should be performed and what modality should b. Mri can often differentiate between pseudocyst and cystic neoplasm. Apr 26, 2017 pancreatitis can be local or diffuse and is classified as acute, chronic, inherited, necrotic, or hemorrhagic.