Pancreatic pseudocyst

Causes

The pancreas is an organ located behind the stomach that 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, acute pancreatitis. Acute pancreatitis is sudden swelling (inflammation) of the pancreas.

A pancreatic pseudocyst may occur in someone with chronic pancreatitis. It may also occur after trauma to the abdomen, more often in children.

The cyst happens when the ducts (tubes) in the pancreas are damaged by the inflammation or swelling that occurs during pancreatitis.

Symptoms

Symptoms can occur within days to months after an attack of pancreatitis, and include:

• Bloating of the abdomen
• Constant pain or deep ache in the abdomen, which may also be felt in the back
• Difficulty eating and digesting food

Exams and Tests

The health care provider may feel your abdomen for a pseudocyst, which feels like a lump in the middle or left upper abdomen.

Tests that may help diagnose pancreatic pseudocyst include:

• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound

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, usually guided by a CT scan
• Endoscopic-assisted drainage using an endoscope (a tube containing a camera and a light that is passed down into the stomach)
• Surgical drainage of the pseudocyst, which involves making a connection 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

• A pancreatic abscess can develop if the pseudocyst becomes infected.
• The pseudocyst can break open (rupture), which 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 an emergency situation. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of bleeding or shock, such as:

• Fainting
• Fever and chills
• Rapid heartbeat
• Severe abdominal pain

Prevention

The way to prevent pancreatic pseudocysts is by preventing pancreatitis. If pancreatitis is caused by gallstones, it is usually necessary to remove the gallbladder with surgery (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. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 146.

Forsmark Ce, Baillie J. AGA Institute Technical Review on acute pancreatitis. Gastroenterology. 2007;132:2022-2044.

Update Date: 2/19/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.