Intrahepatic pancreatic pseudocyst: A review of the world literature

Abstract

AIMTo investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts (IHPP).METHODSA literature search was performed using PubMed (MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P < 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible.RESULTSWe found 41 published articles describing 54 cases since the 1970s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly (48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment (P = 0.006) and with the number of interventions required (P = 0.031). The duration of therapy also correlated with the initial white blood cell (WBC) count (P = 0.048).CONCLUSIONDiagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution.

Intrahepatic Pancreatic Pseudocyst Complicated by Pancreatitis: A Case Report

“…3 In our case, the patient had no history or symptom of acute pancreatitis, and there was no obvious evidence of acute pancreatitis on an image study, except slightly elevated serum amylase and lipase levels. Cystic fluid analysis has limited sensitivity in differentiating the hepatic cystic lesion.…”

“…To date, only about 50 cases of intrahepatic pancreatic pseudocysts (IHPPs) have been reported. 3 Herein, we report a case of IHPP in the left hepatic lobe that has successfully been treated with left hemihepatectomy. (B) Porto-mesenteric junction collapsed by the mass effect of cystic tumor (yellow arrows).…”

Intrahepatic Pancreatic Pseudocyst: a Rare Complication of Pancreatitis

“…An indwelling pigtail catheter was placed under CT guidance with an initial drainage of 500ccs. Fluid analysis revealed amylase >20,000 U/L, lipase >12,000 U/L, and leukocytes 68,000/mm 3 , consistent with a pancreatic pseudocyst. Fluid cultures were negative.…”

“…However, only 22% of these cysts are extra-pancreatic [2]. The average reported diameter is 9.5cm and half of them occur in conjunction with a pancreatic pseudocyst and 48% affect the left lobe of the liver [3]. The mean WBC count was 15,000 and 84% of fluid aspirates were culture negative.…”

“…1). Initial lab work showed no anemia, a leukocytosis of 19,000/mm 3 , sodium 136 mmol/L, potassium 4.6 mmol/L, chloride 90 mmol/L, carbon dioxide 16 mmol/L, creatinine 0.82 mg.dL, and an anion gap of 30. He was treated for diabetic ketoacidosis resulting in an improvement in his abdominal pain.…”