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Pancreatic pseudocyst

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vidhi Patel M.B.B.S.

Synonyms and keywords: Pseudocyst of pancreas

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidhi Patel M.B.B.S.

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Overview

A pancreatic pseudocyst is a circumscribed collection of fluid rich in amylase and other pancreatic enzymes, blood and necrotic tissue typically located in the lesser sac. It has a non-epithelialised lining made of granulation tissue and hence the name pseudocyst (pseudo – false). By contrast, true cysts have an epithelial lining. This is typically a complication due to increased pressure in the pancreatic duct (e.g. stenosis, calculus, protein plugs) or pancreatic necrosis following an episode of acute pancreatitis, but may also occur following abdominal trauma. [1] Pancreatic pseudocyst generally complicates the course of chronic pancreatitis in around 30-40% of the patients.[2]

Historical Perspective

Classification


CLASSIFICATION SCHEME OF PANCREATIC PSEUDOCYST[3]
TYPE DESCRIPTION
I <5cm, without symptoms, complication and neoplasia
II Suspected cystic neoplasia
III Location of Pancreatic Psuedocyst is Uncinate process

IIIa- Pseudocyst communicates with the pancreatic duct.

IIIb- Pseudocyst does not communicate with pancreatic duct.

IV Location of Pancreatic Pseudocyst is Head, Neck and Body.

IVa- Communication exist between pseudocyst and pancreatic duct (1)

IVb- Distance from the cyst to the gastrointestinal wall is <1cm (2)

IVc- Neither 1 nor 2

V Location of Pancreatic Pseudocyst is Tail.

Va- Splenic vein involvement or upper gastrointestinal bleeding

Vb- Distance from the cyst to the gastrointestinal wall is <1cm without splenic vein involvement or upper gastrointestinal bleeding

Pathophysiology

Pancreatic Pseudocyst, also known as “false cyst” as they do not have true epithelial lining. The pathophysiology of pancreatic pseudocyst involves trauma or episode of pancreatitis followed by extravasation of pancreatic secretions.

Causes

Differentiating Pancreatic pseudocyst overview from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

  1. ↑ Cooperman AM. An overview of pancreatic pseudocysts: the emperors new clothes revisited. Surg Clin North Am. Apr 2001;81(2):391-7, xii.
  2. ↑ Habashi S, Draganov PV (2009). “Pancreatic pseudocyst”. World J Gastroenterol. 15 (1): 38–47. doi:10.3748/wjg.15.38. PMC 2653285. PMID 19115466.
  3. ↑ Pan G, Wan MH, Xie KL, Li W, Hu WM, Liu XB; et al. (2015). “Classification and Management of Pancreatic Pseudocysts”. Medicine (Baltimore). 94 (24): e960. doi:10.1097/MD.0000000000000960. PMC 4616556. PMID 26091462.

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Historical Perspective

Historical Perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Overview

Historical Perspective

References

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Classification

Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Overview

Classification

CLASSIFICATION SCHEME OF PANCREATIC PSEUDOCYST[1]
TYPE DESCRIPTION
I <5cm, without symptoms, complication and neoplasia
II Suspected cystic neoplasia
III Location of Pancreatic Psuedocyst is Uncinate process

IIIa- Pseudocyst communicates with the pancreatic duct.

IIIb- Pseudocyst does not communicate with pancreatic duct.

IV Location of Pancreatic Pseudocyst is Head, Neck and Body.

IVa- Communication exist between pseudocyst and pancreatic duct (1)

IVb- Distance from the cyst to the gastrointestinal wall is <1cm (2)

IVc- Neither 1 nor 2

V Location of Pancreatic Pseudocyst is Tail.

Va- Splenic vein involvement or upper gastrointestinal bleeding

Vb- Distance from the cyst to the gastrointestinal wall is <1cm without splenic vein involvement or upper gastrointestinal bleeding

References

  1. ↑ Pan G, Wan MH, Xie KL, Li W, Hu WM, Liu XB; et al. (2015). “Classification and Management of Pancreatic Pseudocysts”. Medicine (Baltimore). 94 (24): e960. doi:10.1097/MD.0000000000000960. PMC 4616556. PMID 26091462.

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Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidhi Patel M.B.B.S.

Overview

Pancreatic Pseudocyst, also known as “false cyst” as they do not have true epithelial lining. The pathophysiology of pancreatic pseudocyst involves trauma or episode of pancreatitis followed by extravasation of pancreatic secretions.

If acute pancreatitis persists more than 4-6 weeks and is seen with a wall of fibrous or granulation tissue which is well-defined, it is called formation of a pseudocyst due to acute pancreatitis which is filled with enzymatic fluid and necrotic debris.

The formation of pancreatic pseudocyst due to chronic pancreatitis is less well understood. It is still believed tp occur either due to episode of acute exacerbation in chronic pancreatitis and/or blockage of pancreatic duct by protein plug or calculus or localized fibrosis.[1]

Pathophysiology

Acute pancreatitis results amongst other things in the disruption of pancreatic parenchyma and the ductal system. This results in extravasation of pancreatic enzymes which in turn digest the adjoining tissues. This results in a collection of fluid containing pancreatic enzymes, hemolysed blood and necrotic debris around the pancreas. The lesser sac being a potential space, the fluid collects here preferentially. This is called an acute pancreatic collection. Some of these collections resolve on their own as the patient recovers from the acute episode. However, others become more organised and get walled-off within a thick wall of granulation tissue and fibrosis. This takes several weeks to occur and results in a pancreatic pseudocyst.

References

  1. ↑ Habashi S, Draganov PV (2009). “Pancreatic pseudocyst”. World J Gastroenterol. 15 (1): 38–47. doi:10.3748/wjg.15.38. PMC 2653285. PMID 19115466.

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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun M.D., PhD.

Overview

Pseudocysts formation mainly occur when the main pancreatic duct or any of its branches get blocked by direct injury or infection. It causes oozing of the pancreatic enzymes into the parenchyma and forms a cyst. Pancreatitis remain the prime cause for the formation of pseudocysts. So, the etiology of pancreatic pseudocysts remains same as the etiology of pancreatitis.

Causes

References

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Differentiating Pancreatic pseudocyst from other Diseases

Differentiating Pancreatic pseudocyst from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Overview

Differentiating Pancreatic pseudocyst from Other Diseases

References

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Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Cafer Zorkun M.D., PhD.

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Overview

Pancreatic pseudocysts account for approximately 75% of all pancreatic masses.[1]

Epidemiology and Demographics

References

  1. ↑ Bradley EL, Gonzalez AC, Clements JL Jr. Acute pancreatic pseudocysts: incidence and implications. Ann Surg. Dec 1976;184(6):734-7.

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Risk Factors

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Overview

Risk Factors

References

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Screening

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Overview

Screening

References

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Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun M.D., PhD.

Please help WikiDoc by adding more content here. It’s easy! Click here to learn about editing.

Overview

Natural History

Complications

  • A pancreatic abscess can develop if the pseudocyst becomes infected
  • Rupture of the pseudocyst
  • The pseudocyst may press down on (compress) nearby organs
  • Abdominal bleeding
  • Shock

Prognosis

The outcome is generally good with treatment.

References

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Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

Related Chapters

Template:Gastroenterology fi:Haiman pseudokysta


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