A pancreatic pseudocyst (PPC) is the most common pancreatic cystic lesion. It frequently arises secondary to acute or chronic pancreatitis, trauma, or surgery, which lead to the leakage and accumulation of pancreatic fluid. It is characterized by a cystic wall that is not lined by epithelial cells. PPC may cause local compression, complicate with bleeding or infection, or rupture spontaneously into the peritoneal cavity or hollow organs.
Clinical Presentation and Diagnosis
PPC can be asymptomatic. As the cyst enlarges, symptoms such as abdominal distension may occur. Compression of the stomach or duodenum may lead to nausea and vomiting. A smooth, hemispherical, non-mobile cystic mass may be palpable in the upper abdomen. In cases of superimposed infection, fever and abdominal pain may develop. PPC should be considered when these symptoms arise following pancreatitis or abdominal trauma. Imaging modalities such as ultrasound, CT, and MRI can confirm the location and size of the cyst.
Treatment
Asymptomatic PPCs are generally managed with dynamic observation. Surgical treatment may be considered under the following circumstances:
- Presence of complications such as bleeding, infection, rupture, or compression of adjacent structures.
- Symptoms such as abdominal pain or jaundice.
- Association with pancreatic duct obstruction or communication with the main pancreatic duct.
- Presence of multiple cysts.
- Difficulty distinguishing the lesion from pancreatic cystic neoplasms (PCNs).
- Progressive enlargement of the cyst.
Common treatment approaches include:
Internal Drainage Procedures
Once the cyst wall has matured (typically after 6 weeks or more), cystojejunostomy or cystogastrostomy may be performed. Endoscopic ultrasound (EUS)-guided transgastric puncture and drainage can also be considered.
External Drainage Procedures
This method is suitable for cysts of shorter duration, those with secondary bacterial infections, cases where percutaneous drainage has failed, or ruptured cysts.
Resection of PPC
This option is applicable for smaller cysts or in cases with multiple PPCs where internal or external drainage has proven ineffective.