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Pancreatic pseudocyst

Definition

A pancreatic pseudocyst is a fluid-filled sac in the abdomen, which may also contain tissue from the pancreas, pancreatic enzymes, and blood.

Causes, incidence, and risk factors

The pancreas is an organ located behind the stomach that produces chemicals (called enzymes) needed to digest food. It also produces the hormones insulin and glucagon.

Pancreatic pseudocysts most often develop after an episode of severe, acute pancreatitis. Acute pancreatitis is sudden swelling (inflammation) of the pancreas.

It may also occur after trauma to the abdomen, more often in children.

The cyst happens when the ducts (tubes) in the pancreas are damaged by the inflammation or swelling that occurs during pancreatitis.

A pancreatic pseudocyst may also occur after trauma to the abdomen, and in someone with chronic pancreatitis.

Symptoms

Symptoms can occur within days to months after an attack of pancreatitis, and include:

• Bloating of the abdomen
• Constant pain or deep ache in the abdomen, which may also be felt in the back
• Difficulty eating and digesting food

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 MRI
• Abdominal ultrasound

Treatment

Treatment depends on the size of the pseudocyst and whether it is causing symptoms. Many pseudocysts go away on their own. Those that remain for more than 6 weeks and are larger than 5 cm in diameter often need surgery.

Surgical treatments include:

• Drainage through the skin (percutaneous) using a needle, usually guided by a CT scan
• Endoscopic-assisted drainage using an endoscope (a tube containing a camera and a light that is passed down into the stomach)
• Surgical drainage of the pseudocyst, which involves making a connection between the cyst and the stomach or small intestine. This may be done using a laparoscope.

Support Groups

Expectations (prognosis)

The outcome is generally good with treatment.

Complications

• A pancreatic abscess can develop if the pseudocyst becomes infected
• The pseudocyst can break open (rupture), which can be a serious complication because shock and excess bleeding (hemorrhage) may develop
• The pseudocyst may press down on (compress) nearby organs

Calling your health care provider

Rupture of the pseudocyst is an emergency situation. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of bleeding or shock, such as:

• Fainting
• Fever and chills
• Rapid heartbeat
• Severe abdominal pain

Prevention

The way to prevent pancreatic pseudocysts is by preventing pancreatitis. If pancreatitis is caused by gallstones, it is usually necessary to remove the gallbladder with surgery (cholecystectomy). When pancreatitis occurs due to alcohol abuse, the patient must stop drinking alcohol to prevent future attacks.

References

Owyang C. Pancreatitis. In: Goldman L, Ausiello D, eds. . 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 147.