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Pancreatic pseudocyst

Pancreatitis - pseudocyst

 

A pancreatic pseudocyst is a fluid-filled sac in the abdomen. It may also contain tissue from the pancreas, enzymes, and blood.

Causes

 

The pancreas is an organ located behind the stomach. It produces chemicals (called enzymes) needed to digest food. It also produces the hormones insulin and glucagon.

Pancreatic pseudocysts most often develop after an episode of sudden, severe pancreatitis. Pancreatitis is sudden swelling of the pancreas. There are many causes of this problem.

This problem may sometimes occur:

  • In someone with chronic swelling of the pancreas
  • After trauma to the belly, more often in children

The cyst happens when the ducts (tubes) in the pancreas are damaged and fluid with enzymes cannot drain.

 

Symptoms

 

Symptoms can occur within days to months after an attack of pancreatitis, and include:

  • Bloating of the abdomen
  • Constant pain or deep ache in the abdomen, which may also be felt in the back
  • Difficulty eating and digesting food

 

Exams and Tests

 

The health care provider may feel your abdomen for a pseudocyst. It will feel like a lump in the middle or left upper abdomen.

Tests that may help diagnose pancreatic pseudocyst include:

  • Abdominal CT scan
  • Abdominal MRI
  • Abdominal ultrasound
  • Endoscopic ultrasound (EUS)

 

Treatment

 

Treatment depends on the size of the pseudocyst and whether it is causing symptoms. Many pseudocysts go away on their own. Those that remain for more than 6 weeks and are larger than 5 cm in diameter often need treatment.

Possible treatments include:

  • Drainage through the skin using a needle, most often guided by a CT scan
  • Endoscopic-assisted drainage using an endoscope (a tube containing a camera and a light that is passed down into the stomach)
  • Surgical drainage of the pseudocyst, which involves making a connection between the cyst and the stomach or small intestine. This may be done using a laparoscope.

 

Outlook (Prognosis)

 

The outcome is generally good with treatment. It is important to make sure that it is not a pancreatic cancer that starts in a cyst, which has a worse outcome.

 

Possible Complications

 

Complications may include:

  • A pancreatic abscess can develop if the pseudocyst becomes infected.
  • The pseudocyst can break open (rupture), which can be a serious complication because shock and excess bleeding (hemorrhage) may develop.
  • The pseudocyst may press down on (compress) nearby organs.

 

When to Contact a Medical Professional

 

Rupture of the pseudocyst is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of bleeding or shock, such as:

  • Fainting
  • Fever and chills
  • Rapid heartbeat
  • Severe abdominal pain

 

Prevention

 

The way to prevent pancreatic pseudocysts is by preventing pancreatitis. If pancreatitis is caused by gallstones, it is often necessary to remove the gallbladder with surgery (cholecystectomy).

When pancreatitis occurs due to alcohol abuse, you must stop drinking alcohol to prevent future attacks.

When pancreatitis occurs due to high blood triglycerides, this condition should be treated.

 

 

References

Forsmark CE. Pancreatitis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 144.

Forsmark CE, Baillie J. AGA Institute Technical Review on acute pancreatitis. Gastroenterology. 2007;132:2022-2044. PMID: 17484894 www.ncbi.nlm.nih.gov/pubmed/17484894.

Tenner SC, Steinberg WM. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 58.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • Pancreatic pseudocyst, CT scan

    Pancreatic pseudocyst, CT scan - illustration

    A CT scan of the upper abdomen showing a pseudocyst in the corpus, or tail, of the pancreas.

    Pancreatic pseudocyst, CT scan

    illustration

  • Pancreas

    Pancreas - illustration

    The pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.

    Pancreas

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Pancreatic pseudocyst, CT scan

      Pancreatic pseudocyst, CT scan - illustration

      A CT scan of the upper abdomen showing a pseudocyst in the corpus, or tail, of the pancreas.

      Pancreatic pseudocyst, CT scan

      illustration

    • Pancreas

      Pancreas - illustration

      The pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.

      Pancreas

      illustration

    Talking to your MD

     

      Tests for Pancreatic pseudocyst

       

         

        Review Date: 10/27/2015

        Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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