Pancreatic pseudocyst 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

↑ Cooperman AM. An overview of pancreatic pseudocysts: the emperors new clothes revisited. Surg Clin North Am. Apr 2001;81(2):391-7, xii.
↑ Habashi S, Draganov PV (2009). “Pancreatic pseudocyst”. World J Gastroenterol. 15 (1): 38–47. doi:10.3748/wjg.15.38. PMC 2653285. PMID 19115466.
↑ 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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[1] Cooperman AM. An overview of pancreatic pseudocysts: the emperors new clothes revisited. Surg Clin North Am. Apr 2001;81(2):391-7, xii.

[pmid19115466-2] Habashi S, Draganov PV (2009). “Pancreatic pseudocyst”. World J Gastroenterol. 15 (1): 38–47. doi:10.3748/wjg.15.38. PMC 2653285. PMID 19115466.

[pmid26091462-3] 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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