Chronic Pancreatitis and Pancreatic Pseudocysts

Abstract

Although chronic pancreatitis has a variety of clinical manifestations, most commonly patients present with intermittent chronic abdominal pain. The pain originates from a myriad of protean manifestations, including infl ammation and increased ductal and/or parenchymal pressure. In select patients, endoscopic or surgical decompression of the pancreatic duct has been shown to decrease pain. Pancreatic duct disruption and/or increased pancreatic ductal pressure can lead to a pseudocyst formation. In patients with chronic pancreatitis, the pancreatic duct becomes obstructed by fi brous scarring, inspissated protein, or stone(s), and the ongoing pancreatic secretion proximal to the obstruction leads to a saccular dilation of the duct, fi lled with pancreatic juice. These pseudocysts can cause symptoms of pain, early satiety, nausea, vomiting, weight loss, and can be complicated by obstruction (biliary and or enteric), hemorrhage, and infection. In the patient with chronic pancreatitis who develops a symptomatic pseudocyst(s), a multidisciplinary approach to drain these cysts, including endoscopic, surgical, and percutaneous methods, should be considered depending on local expertise and the character and location of the pseudocyst.