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Pancreatic pseudocyst

Pancreatitis - pseudocyst

A pancreatic pseudocyst is a fluid-filled sac in the abdomen that arises from the pancreas. 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 severe pancreatitis. Pancreatitis happens when your pancreas get inflamed. There are many causes of this problem.

This problem may sometimes occur:

  • In someone with long-term (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. They include:

  • Bloating of the abdomen
  • Constant pain or deep ache in the abdomen, which may also be felt in the back
  • Nausea and vomiting
  • Loss of appetite
  • 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 detect pancreatic pseudocyst include:

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. In this, a tube containing a camera and a light is passed down into the stomach)
  • Surgical drainage of the pseudocyst. A connection is made 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). This 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:

Prevention

The way to prevent pancreatic pseudocysts is by preventing pancreatitis. If pancreatitis is caused by gallstones, the provider will perform surgery to remove the gallbladder (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-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 144.

Nealon WH. The management of pancreatic pseudocyst. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:516-523.

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

Van Buren G, Fisher WE. Acute and chronic pancreatitis. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier; 2018:163-170.

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    • Digestive system

      Digestive system

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    • Endocrine glands

      Endocrine glands

      illustration

    • Pancreatic pseudocyst - CT scan

      Pancreatic pseudocyst - ...

      illustration

    • Pancreas

      Pancreas

      illustration

      • Digestive system

        Digestive system

        illustration

      • Endocrine glands

        Endocrine glands

        illustration

      • Pancreatic pseudocyst - CT scan

        Pancreatic pseudocyst - ...

        illustration

      • Pancreas

        Pancreas

        illustration

       

      Review Date: 10/23/2017

      Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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