The natural and unnatural history of pancreatic pseudocysts

Abstract

Experience with 131 pseudocysts of the pancreas in 112 patients has been analysed with a view to answering specific questions. Spontaneous regression was documented in 8 per cent. Complications occurred in 33-5 per cent of the pseudocysts, including obstruction of adjacent organs, rupture, haemorrhage and pancreatic ascites. In 14 pseudocysts, rupture into the gastrointestinal tract, the peritoneal cavity or the pleural cavity when unassociated with haemorrhage, had a mortality rate of 14 per cent. Sixteen patients with significant haemorrhage associated with a pseudocyst had a mortality rate of 61 per cent; early direct surgical control is advocated. Pancreatic ascites was associated with 14-5 per cent of the pseudocysts and had a 40 per cent recurrence rate, which can be greatly diminished when operative procedures are guided by pancreatography. The mortality rate for the surgical treatment of 97 uncomplicated pseudocysts was 6 per cent and the recurrence rate was 11 per cent. The prime cause of death was haemorrhage. Seven of the 131 pseudocysts were synchronous and 12 were metachronous. The actual figure is probably higher. Small cysts of the head of the pancreas, impalpable at operation but demonstrable by pancreatography, may be the cause of severe, continuing or recurrent symptoms.

Minute Splenic Pseudoaneurysm Causing Hemorrhage within a Pancreatic Pseudocyst: The Utility of CT during Splenic Arteriography

“…A mechanism explaining the development of intracystic bleeding has been considered: a hemorrhage from a false aneurysm created by inflammatory influence or the infiltration of pancreatic enzyme [6][7]. Bleeding pseudocysts were reported to be present in 6%-7.5% of patients with pancreatic pseudocysts [6][7].…”

“…A mechanism explaining the development of intracystic bleeding has been considered: a hemorrhage from a false aneurysm created by inflammatory influence or the infiltration of pancreatic enzyme [6][7]. Bleeding pseudocysts were reported to be present in 6%-7.5% of patients with pancreatic pseudocysts [6][7]. Frey [8] noted that intracystic hemorrhage was a complication in 10 (7.6%) of 131 cases of pancreatic pseudocysts, and a false aneurysm was confirmed in 9 (90%) of these 10 cases.…”

“…Regarding the patient's clinical course, because his laboratory data at admission showed an increased serum level of amylase (160 U/L, normal range 30-120 U/L), normal white blood cell (WBC) count (7,450, normal range 3,500-9,000/μL) and normal C-reactive protein (CRP: 0.07 mg/dL, normal range 0-0.3 mg/dL), he was diagnosed as having an acute exacerbation of chronic pancreatitis. After his hospitalization, fever occurred and abnormal values of laboratory data such as WBC count (11,420/μL), serum amylase (275 U/L), lactate dehydrogenase (LDH: 402 U/L, normal range 119-229 U/L), and increased C-reactive protein (CRP: 21.18 mg/dL) were recognized.…”

Novel endoscopic management for pancreatic pseudocyst with fistula to the common bile duct

“…It affects more frequently males, most common etiology is alcoholic chronic pancreatitis and abdominal pain is the main clinical presentation. To the best of our knowledge, there have been 17 cases reported in the literature [10][11][12][13][14][15][16][17][18][19][20][21][22][23] , only three of which managed endoscopically [21][22][23] . We present a case of this rare condition successfully resolved performing a simultaneous, independent drainage of the PPs and the CBD, never reported in literature.…”

Pancreaticobiliary Fistula Evident after ESWL Treatment of Pancreatolithiasis

“…Pancreaticobiliary fistula is a rare condition generally associated with pancreatic pseudocysts (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), acute necrotizing pancreatitis (19,20), pancreatic abscesses (21,22), and intraductal papillary-mucinous pancreatic neoplasm (IPMN) (23)(24)(25). This pathological condition generally presents symptoms such as hemobilia or obstructive jaundice soon after fistulous formation, or is found pathologically after operation on pancreatic pseudocysts caused by acute pancreatitis (13 …”