Thursday, March 24, 2011

Pancreatic Pseudocyst

A pancreatic pseudocyst is a localized collection of tissue, fluid, debris, pancreatic enzymes, and blood in the abdomen. The prefix "pseudo-" means "false", which distinguishes them from true cysts, which are lined by epithelium. Thus, a pseudocysts is best defined as a localized fluid collection that is rich in amylase and other pancreatic enzymes, that is lined by a nonepithelialized wall consisting of fibrous and granulation tissue, and that usually appears several weeks after the onset of pancreatitis. Complication of pancreatic pseudocyst include infection, hemorrhage, obstruction and rupture. For obstruction, it can cause compression in the GI tract from the stomach to colon, compression in urinary system, biliary system, and arteriovenous system.

Pancreatic pseudocysts can be single or multiple. Multiple cysts are more frequently observed in patients with alcoholism, and they can be multiple in about 15% of cases. Size varies from 2-30 cm. About one third of pseudocysts manifest in the head of the gland, and two thirds appear in the tail. The fluid in pseudocysts has been well characterized as clear or watery, or it can be xanthochromic. The fluid in pseudocysts usually contains very high amounts of amylase, lipase, and trypsin, though the amylase level may decrease over time.

The symptoms of pancreatic pseudocyst are abdominal mass, persisten abdominal pain, and inability to eat. The treament for this pancreatic condition include endoscopic transgastric drainage, imaging guided percutaneous drainage, and laparoscopic/open cystogastrostomy.