Management of pancreatic fluid collections pushpak taunk, m. Pancreatic pseudocysts and walledoff pancreatic necrosis are often the result of acute pancreatitis. Methods an online survey in pubmed was conducted using the terms acute pancreatitiscomplications, pancreatic pseudocyst and pancreatic pseudocyst treatment. Pdf a clinical study of pancreatic pseudocyst and its. Delineation of the anatomy with mrcp or ercp is the first step in management. Endoscopic cyst gastrostomy for traumatic pancreatic. Diagnosis and management of pancreatic in a significant number of acute cases, the cyst contents pseudocysts, pancreatic ascites. If nonsurgical drainage is contemplated, it is important to elucidate the anatomy of the pancreatic duct beforehand. Review of management options for pancreatic pseudocysts ncbi. According to the atlanta classification an acute pseudocyst is a collection of pancreatic. Pancreatic pseudocysts may be a result of acute or chronic pancreatitis and trauma including postsurgical. Endoscopic drainage of pancreatic pseudocysts guided by endosonography. Patients with asymptomatic cysts that are diagnosed as pseudocysts on initial imaging and. Much debate exists regarding which of these approaches is superior and when each is most appropriate.
Pancreatic pseudocysts are collections of leaked pancreatic fluids. Pediatric pancreatitis and pancreatic pseudocyst treatment. Pdf classification and management of pancreatic pseudocysts. Read diagnosis and management of pancreatic pseudocysts. An endoscopic ultrasound eusguided transgastric endoscopic approach is preferred if there is favourable access to the pp. Pseudocyst of the pancreas the role of cytology and special stains for mucin elvira gonzalez obeso, md 1, erin murphy, md, william brugge, md2, and vikram deshpande, md background. Pdf surgical treatment of pancreatic pseudocysts researchgate. Laparoscopic management of pancreatic pseudocysts offers the benefits of minimal access surgery to patients.
Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery. Modern management of pancreatic pseudocysts grace 1993. The role of endoscopy in the diagnosis and treatment of. Classification and management of pancreatic pseudocysts. Management of pancreatic pseudocysts is associated with considerable morbidity 15 25%. Its role in the management of pancreatic pseudocyst is gaining momentum in this era of minimal access surgery as the scope of laparoscopy widens with advancement of medical technology. Spontaneous resolution of large pseudocysts is known to occur. Two patients 6% had persistent chronic pain and one patient 3% had evidence of exocrine pancreatic insufficiency with malabsorption.
However, no scientific classification of pancreatic pseudocysts has been devised, which could assist in the selection of optimal therapy. More randomized studies are needed to look at the long term outcome and cost effectiveness of metal stent use in pancreatic pseudocyst management. Many resolve without intervention, and the management of symptomatic pseudocysts that persist remains controversial, with various open, percutaneous and laparoscopic approaches to intervention described. Classification and management of pancreatic pseudocysts ncbi. Evidencebased treatment of pancreatic pseudocysts see equal ef. Get a printable copy pdf file of the complete article 773k. A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen. The evaluation and management of pancreatic pseudocysts has changed dramatically. Traditionally, pancreatic pseudocysts have been drained because of the perceived risks ofcomplications including infection, rupture or haemorrhage. See equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial, by varadarajulu s. Management of pancreatic pseudocysts edinburgh research. Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. If not, or if it causes a lot of pain or other symptoms. If a pseudocyst is small and not causing serious symptoms, a doctor may want to.
Patients who are not medically fi t for surgery should not undergo further evaluation of incidentally found pancreatic cysts, irrespective of cyst size strong recommendation, low quality of evidence 5. However, when symptoms become persistent, complications emerge, or cysts become larger than 6 centimeters in size, drainage is indicated. Currently, the preoperative diagnosis of a pancreatic cyst is based on clinical and imaging. Management of symptomatic pancreatic pseudocyst springerlink. See equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a. Pseudocysts are collections of amylaserich pancreatic juice surrounded by a wall of granulation tissue that arise following acute pancreatic inflammation or trauma, and normally form over several weeks fig. Pdf management of pancreatic pseudocysts stig bengmark. Therefore, being a minimally invasive technique, endoscopic drainage could be an appropriate alternative to surgery in the management of pancreatic pseudocysts. Successful endoscopic cyst gastrostomy has been reported in children with pancreatic pseudocysts. Surgical internal drainage of pancreatic pseudocysts can be performed safely with low morbidity and mortality provided patients are carefully selected and their medical management is optimized. Pancreas pseudocyst an overview sciencedirect topics. Full text full text is available as a scanned copy of the original print version.
T he evaluation and management of pancreatic pseudocysts has changed dramatically. Pdf according to the atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation. Review of management options for pancreatic pseudocysts. In our study, the resolution rate of pancreatic pseudocysts did not differ significantly between the surgical and the endoscopic groups 93. The traditional management of pancreatic pseudocyst pp is surgical drainage. This change has largely been driven by better natural history data and by an increasing focus on minimally invasive approaches, but has occurred in the absence of highquality comparative effectiveness data. Pancreatic pseudocysts vanderbilt university medical center. A pancreatic pseudocyst happens when the ducts in your pancreas get blocked because of disease or injury. More commonly seen in won than pseudocysts pancreatic duct leaks lead to recurrence of fluid collections. Management of pancreatic pseudocysts and walledoff pancreatic. Traditional surgical approaches to the management of pseudocyst are now being challenged by endoscopic techniques and interventional radiology.
This case report describes a rare complication of an eusguided transgastric drainage of a pp secondary to a suboptimally. Open surgical drainage to the stomach or a jejunal roux limb, the primary therapy. Pancreatic cysts and pseudocysts management and treatment. Diagnosis and management of pancreatic pseudocysts. Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery, have been employed for the management of pancreatic pseudocysts. Evaluation and management of pancreatic pseudocysts. However, no scientific classification of pancreatic pseudocysts has been devised, which could assist in the selection of. The role of surgery in the management of acute pancreatitis. Gastroscopic and ultrasoundguided percutaneous cystgastrostomy. Although a leaking pancreatic pseudocyst was the cause of ascites in at least 21 episodes 70%, an abdominal mass could only be palpated in two of 26 patients. Pdf treatment of pancreatic pseudocysts researchgate. Management options for pancreatic pseudocyst are numerous and include endoscopic and surgical approaches. Although pseudocyst formation is an uncommon sequela of acute or chronic pancreatitis in children, complications of pancreatic pseudocysts include spontaneous rupture, hemorrhage, and infection. It makes fluids that flow through a duct into the small intestine.
Pdf a pancreatic pseudocyst is the collection of pancreatic secretions surrounded by fibrous tissue caused by pancreatic disease that affects. Management of pancreatic pseudocysts andersson 1989. Links to pubmed are also available for selected references. The management of pancreatic pseudocysts is complex and can range from simple observation to aggressive endoscopic and surgical interventions to treat symptomatic lesions. Patients with asymptomatic cysts that are diagnosed as pseudocysts. Pancreatic pseudocyst is a welldefined fluid collection, but without solid components, which occurs 4 weeks after an interstitial or edematous pancreatitis episode. The small risk of malignant transformation, the high risks of surgical treatment, and the lack of highquality prospective studies have led to contradictory recommendations for their immediate management and for their surveillance. Management of pancreatic pseudocystsa retrospective analysis. Pancreatic pseudocyst most common cystic lesions of the pancreas, accounting for 7580% of such masses location lesser peritoneal sac in proximity to the pancreas large pseudocysts can extend into the paracolic gutters, pelvis, mediastinum, neck or scrotum may be loculated 4. It gives an introduction to pancreatic cancer, explains your diagnosis, and provides an overview of the treatment options. Management of pseudocysts requires a team approach.
Partners, family members and friends may also find it useful. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic. Gastroenterologists, surgeons, and invasive radiologists must work together to determine the necessity, timing, and method of intervention. Get a printable copy pdf file of the complete article 773k, or click on a page image below to browse page by page. Often pseudocysts get better and go away on their own. Background pancreatic pseudocysts may develop after highgrade pancreatic injuries in children. Abstractthis article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. Management of pancreatic pseudocystsa retrospective. Metal stents in management of pancreatic pseudocyst and. Pdf management of pancreatic pseudocysts magnus janzon. Between 1969 and 1987, 68 patients with pancreatic pseudocysts were treated.
Roentgenographic series of the upper part of the gastrointestinal tract failed to demonstrate pancreatic pseudocyst in 7. Some have suggested that pseudocysts associated with acute pancreatitis are more likely to contain inflamma tory fluid 21 than pancreatic juice, but there are. Most pseudocysts resolve on their own without treatment, over time. Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal trauma. This article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. A pseudocyst in connection with the main pancreatic duct and with otherwise normal pancreatic duct anatomy can often be well treated with ercpguided sphincterotomy or trans.
Pseudocysts can be medically managed with pancreatic rest or surgically by internal or external drainage. They may form next to the pancreas during pancreatitis. It also has information about the wider impact of being diagnosed with pancreatic cancer, and the. Aspiration or catheter drainage of pseudocyst fluid guided by ultrasonography seems a safe and effective treatment of pancreatic pseudocysts and should be considered as initial therapy. Early management focuses on advancements in our understanding of aggressive intravenous hydration, which when applied early appears to decrease morbidity and mortality 9,10. We have adopted a more conservativeapproach with drainage only for uncontrolled pain or gastric outlet obstruction. Pseudocysts during chronic calcifying pancreatitis ccp. The management of pancreatic pseudocyst katherine a. Diagnosis and management of pancreatic pseudocysts, pancreatic. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses. Management of a recurrent pancreatic pseudocyst sages. Pancreatic pseudocysts arise mostly in patients with alcohol induced chronic pancreatitis causing various symptoms and complications. Robert zollinger, md overview the pancreatic pseudocyst is a collection of pancreatic secretions contained within a fibrous sac comprised of chronic inflammatory.
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