What are Pancreatic Pseudocysts?

The pancreas is an important component of the digestive system. It is essentially a gland which helps in the digestion of the food by secreting enzymes. It also produces hormones namely, insulin (important for sugar metabolism), glucagon and somatostatin.

Pancreatic Pseudocysts

are fluid filled sacs placed in the abdomen which contain secretions from damaged pancreatic ducts, pancreatic enzymes, blood and necrotic (dying) pancreatic tissue.

Of all the the types of cystic pancreatic lesions, the discussed type accounts for 75-80% of such occurrences. Unlike proper cysts, pseudocysts do not posses a lining of epithelial cells. Rather they are lined with granulation tissue (fibrous connective tissue which helps in healing wounds).

Morbidity rates after surgical management of the pseudocyst can range from 4 to 30%.


Causes of Pancreatic Pseudocysts

  • Acute pancreatitis sometimes results in the discussed condition. Acute pancreatitis is generally associated with a sudden inflammation of the pancreas.
  • Inflammation can damage the pancreatic ducts which leads to the excess secretions from the pancreas and the formation of a pseudocyst.
  • An accidental injury or trauma could lead to the condition. This is especially true when it comes to children.
  • Chronic pancreatitis caused by prolonged alcohol abuse can also be the reason behind the condition.

Symptoms of the condition

  • Constant and sharp pain in the abdomen.
  • The abdominal pain can radiate towards the back.
  • Nausea and vomiting.
  • Early satiation from meals.
  • Tenderness in the abdomen along with a certain level of abdominal distention.
  • Bloating of the abdomen.
  • Food is eaten and digested with great difficulty.
  • The condition as well as the symptoms may persist for more than 4 weeks.
  • The smaller structures can be limited to the free peritoneal space ( the space between the membranous lining of the abdominal organs and the abdominal wall).
  • The larger structures can extend into the paracolic gutters (space between the abdominal wall and the colon), pelvis, thorax, neck or scrotum.

Diagnosis of the condition

  • The health care provider may feel a soft palpable mass in the middle or upper abdomen on physical examination of the patient.
  • Tests like Ultrasound, CT Scan, MRI, Endoscopic Ultrasonography and ERCP of the abdomen may be needed to confirm the presence of a pseudocyst.

Treatment of Pancreatic Pseudocyst

  • The size of the pseudocyst generally determines the line of treatment.
  • For smaller ones treatment may not be necessary and can be resolved on their own. About a third of the cases do not require any treatment.
  • Larger ones which are more than 5cm in diameter and and are older than 6 weeks may need surgical aspiration and removal.
  • Draining the fluid from the structure through a perforforation in the skin using a needle under the guidance of a CT Scan is a common procedure in treating them.
  • The same aspiration of the fluid and drainage can be done with the help of an endoscope.
  • Surgery is required when draining the fluid involves making a connection between the fluid filled sac and the small intestine or the abdominal wall.
  • Antibiotics are needed to treat the remnant infection.

Complications from the above condition

    The condition can lead to certain complications which are as follows:

    • High Fever, worsening abdominal pain and signs of a spreading infection as in sepsis.
    • Gastrointestinal obstruction.
    • Abdominal wall perforation.
    • Hemorrhage as in bleeding from pseudoaneurysyms associated with pseudocysts. Pseudoaneurysms are caused in blood vessels. In this case, the pancreatic arteries get eroded and drain in the the fuild filled cysts causing bleeding.
    • Thrombosis or blood clot in the arteries around the pancreas could be caused.
    • Formation of pancreatic fistulas which could lead to accumulation of fluids in the cavity close to the lungs and can cause pleural effusion and breathing problems.

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