Pancreatic Pseudocyst: Symptoms, Causes and Treatment

Pancreas is a leaf shaped organ behind the stomach which helps in the secretion of digestive juices and hormones. A pseudocyst is a false cyst means it looks like a cyst grossly but has different tissue component than a true cyst. A pancreatic pseudocyst is not always dangerous but it becomes life threatening when it ruptures. They are filled with the collection of the fluid rich in pancreatic enzymes and their wall is made from fibrous material. Patient usually complaints of persistent abdominal pain or fever but there are no specific set of signs and symptoms.

Symptoms of Pancreatic Pseudocyst

Most of the time symptoms are vague. Pseudocysts are commonly found during a CT or MRI scan of the abdomen which is done for different purpose but can be suggestive if you have

• Recent pancreatitis and persistent pain in the abdomen
• Nausea and vomiting
• Yellowing of the skin or white of the eye
• A lump in the abdomen

Symptoms associated with the ruptured cysts are:

• Fever
• Rapid heart rate
• Severe abdominal pain
• Vomit in the blood

These symptoms can be life threatening and you need to seek immediate care from a physician.

Complications of Pancreatic Pseudocyst

Bleeding and rupture are the most fearful complications of the pancreatic cyst. Rarely, rupture can lead to peritonitis and can cause death.

Causes of Pancreatic Pseudocyst

These cysts can be single or multiple and multiple cysts are more commonly associated with alcoholic patients. Studies shows that 75-85% of cases are associated with pancreatitis caused by alcohol or gallstones disease. Injury is also associated with pancreatic pseudocysts but this association can be due to the reason that a blow to the abdomen may lead to the rupturing of the cyst and most of the time it is a ruptured cyst which causes the problem

Diagnosis of Pancreatic Pseudocyst

Your doctor will use your medical history, conduct a physical exam and perform some tests to find whether you have a pancreatic pseudocyst or not.

Medical history: Your doctor will ask you complete details about your

• Signs and symptoms
• Present or past illness like pancreatitis
• Current or past medications
• History of alcohol consumption

Physical examination: your doctor will examine your body from head to tail but he or she will specifically examine the abdomen to find any tenderness, palpable mass, peritoneal signs.

Imaging tests: If your doctor suspects that you can have pancreatic cysts then imaging tests can be ordered to get a better look at the structure of the pancreas and these includes

• Ultrasonography: Endoscopic ultrasonography can be used to visualize the internal structures of the organ with the help of an endoscope.
• CT scan: it is the standard imaging tests to establish the diagnosis of pancreatic pseudocysts. It has a sensitivity range of about 90-100%.
• MRI scan: It is useful in detecting a solid component in the tumor but not required to establish a diagnosis.

Treatment of Pancreatic Pseudocyst

The goal of treatment is to avoid the complications. Most of the pseudocyst are asymptomatic and require supportive care only. Imaging tests are required to assess the size of the pseudocyst, periodically. Some pseudocysts are symptomatic because they compress the adjacent structure or have been ruptured.

To reduce the size of the cyst, your doctor will drain out the contents of the pseudocyst. This is done under anesthesia. There are various drainage techniques like catheter, endoscopic or surgical. The surgical drainage and endoscopic drainage are treatment of choice as they have high success rate and low mortality and complication rate.

Prognosis of Pancreatic Pseudocyst

Most of the pseudocysts resolve by their own without any interventions and patients do very well but the outcome of the patients is worse who have developed complications.

Resources:

• American Gastroenterological Association
• About chronic pancreatitis. (n.d.).