Pancreatic pseudocyst
2565995
223585719
2008-07-04T19:13:36Z
Arcadian
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wik Pseudocyst
{{Infobox Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
ICD10 = {{ICD10|K|86|3|k|80}} |
ICD9 = {{ICD9|577.2}} |
DiseasesDB = 9530 |
ICDO = |
OMIM = |
MedlinePlus = 000272 |
eMedicineSubj = med |
eMedicineTopic = 2674 |
eMedicine_mult = {{eMedicine2|radio|576}} |
MeshID = D010192 |
}}
A '''pancreatic pseudocyst''' is a circumscribed collection of fluid rich in [[pancreatic enzyme]]s, [[blood]], and [[necrotic tissue]], typically located in the [[lesser sac]] of the abdomen. Pancreatic pseudocysts are usually complications of [[pancreatitis]], although in children they frequently occur following abdominal [[physical trauma|trauma]]. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses. The prefix ''pseudo-'' ([[Latin language|Latin]] for "false") distinguishes them from true [[cyst]]s, which are lined by [[epithelium]]; [[pseudocyst]]s are lined with [[granulation tissue]].
==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.
==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).
* [[Computerized tomography]] - This is the gold standard for initial assessment and follow-up
* [[Magnetic resonance cholangiopancreatography]] (MRCP) - 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:
* [[Gastroscopy|Endoscopic]] trans-gastric drainage
* Imaging guided percutaneous drainage
* Laparoscopic/open cystogastrostomy
{{Gastroenterology}}
[[Category:Diseases]]
[[de:Pankreaszyste]]
[[fi:Haiman pseudokysta]]