Pancreatic pseudocyst

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{{#if: | {{#if: | {{#if: K 86.3| {{#if: 577.2| {{#if: | {{#if: | {{#if: 9530| {{#if: 000272| {{#if: med| {{#if: D010192| {{#if: |

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Pancreatic pseudocyst Classification & external resources
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ICD-10	K 86.3}}
ICD-9	577.2}}
ICD-O:	}}
OMIM	[1] }}
DiseasesDB	9530 }}
MedlinePlus	000272 }}
eMedicine	search \| topic list \| med/2674 }} radio/576}}
MeSH	D010192 }}
MeSH	{{{MeshNumber}}}}}

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 of acute pancreatitis, but may also occur following abdominal trauma. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses.

Etiopathogenesis

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.

Investigations

The questions that need to be answered are:

where, how big and how many?
is there a communication with the pancreatic ductal system? Draining such a pseudocyst carries an increased risk of pancreatic fistula.

The most useful imaging tools are

Ultrasonography - The role of ultrasonography in imaging the pancreas is limited by patient habitus, operator experience and the fact that the pancreas lies behind the stomach (and so a gas-filled stomach will obscure the pancreas).
Computerised tomography - This is the gold standard for initial assessment and follow-up
Magnetic Resonance Cholangio-pancreatography - to establish the relationship of the pseudocyst to the pancreatic ducts

Treatment

A small pseudocyst that is not causing any symptoms may be managed conservatively. However, a large proportion of them will need some form of treatment, The interventions available are:

Endoscopic trans-gastric drainage
Imaging guided percutaneous drainage
Laparoscopic/open cystogastrostomy

{{#if:|}}{{#if:Esophagitis - GERD - Achalasia - Boerhaave syndrome - Nutcracker esophagus - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus|{{#if:|{{#ifeq:{{#if:Esophagus Stomach/
duodenum HerniaNoninfective enteritis and colitisOther intestinalLiver/hepatitisAccessory digestiveOther/general|false|true}}|true|}}}}{{#if:Esophagus|}}{{#if:|}}}}{{#if:Peptic (gastric/duodenal) ulcer - Gastritis - Gastroenteritis - Duodenitis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy|{{#if:Stomach/
duodenum|}}}}{{#if:Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus|{{#if:Hernia|}}}}{{#if:IBD (Crohn's, Ulcerative colitis) - noninfective gastroenteritis|{{#if:Noninfective enteritis and colitis|}}}}{{#if:vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS
other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis)|{{#if:Other intestinal|}}}}{{#if:Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome|{{#if:Liver/hepatitis|}}}}{{#if:Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses)

Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis)

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{{#ifeq:\|plain\|\|{{#if:\| \| }}{{#ifeq:1\|1\|\|This box: }}{{#ifeq:\|1\|{{#if:\|view\|v}}\|{{#if:1\|v\|view}} • {{#if:1\|d\|talk}} • {{#if:1\|e\|edit}}}}{{#if:\|</span> \| }} }} Digestive system - Gastroenterology (primarily K20-K93, 530-579)

	Esophagus	Esophagitis - GERD - Achalasia - Boerhaave syndrome - Nutcracker esophagus - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus
Stomach/ duodenum	Peptic (gastric/duodenal) ulcer - Gastritis - Gastroenteritis - Duodenitis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy
Hernia	Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus
Noninfective enteritis and colitis	IBD (Crohn's, Ulcerative colitis) - noninfective gastroenteritis
Other intestinal	vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis)
Liver/hepatitis	Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome
Accessory digestive	Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses) Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis) Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis)
Other/general	Appendicitis - Peritonitis (Spontaneous bacterial peritonitis) Malabsorption (celiac, Tropical sprue, Blind loop syndrome, Whipple's) postprocedural: Gastric dumping syndrome - Postcholecystectomy syndrome bleeding: Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower)
	See also congenital