Clinical study and management of pseudocyst of pancreas
DOI:
https://doi.org/10.18203/2349-2902.isj20171155Keywords:
CECT, Cystogastrostomy, Cystojejunostomy Endoscopic drainage, Pancreatitis, Pseudocyst pancreasAbstract
Background: Pancreatic pseudocysts can occur as a complication of acute or chronic pancreatitis. Understanding of pseudocysts has changed with times due to advancement in radiology and introduction of new treatment modalities. This study was done to access clinical features etiology and various managements for pseudocyst in a tertiary care hospital.
Methods: It is a prospective study of 40 adult patients admitted in Victoria and Bowring and Lady Curzon Hospital, attached to Bangalore Medical College and Research Institute, Karnataka, India from January 2015 to December 2016.
Results: Pseudocysts are more common in males. The commonest etiology associated was alcohol. Ultrasound was the basic radiological investigation done in all patients followed by CECT abdomen. Complications associated with pseudocyst were Gastric outlet obstruction and ascites. Internal drainage was done in most of the patients. Post drainage complications included infection which was managed by antibiotics and endoscopic drainage in case of recollection. Pain was most important post-operative complication. Endoscopic drainage is being preferred as it is less invasive, has a high long term success rate, has shorter duration of hospital stay and more patient comfort.
Conclusions: Pseudocyst of pancreas is most commonly seen in males
probably because of alcoholism. Clinical presentation can be varied, with pain abdomen being the most common complaint followed by, nausea vomiting. Initial management consists of supportive care and if the symptoms persist and complications develop surgical drainage was the most common management modality. Newer modalities of treatments like endoscopic intervention have an added advantage of lesser pain, shorter duration of hospital stay and recurrence.
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References
Habashi S, Draganov PV. Pancreatic pseudocyst. World J Gastroenterol. 2009;15:38-47.
Cannon JW, Callery MP, Vollmer CM. Diagnosis and management of pancreas pseudocysts: what is the evidence? J Am Coll Surg. 2009;209:385-93.
Morgan DE, Baron TH, Smith JK, Robbin ML, Kenney PJ. Pancreatic fluid collection spriorto intervention: evaluation with MR imaging compared with CT and US. Radiology. 1997;203:773-8.
Callery MP, Meyers WC. Surgical treatment of pseudocysts after acute pancreatitis In Beger HG, Warshaw A, Carr-Locke DL, Russel RCG, Büchler M, Neoptolemos JP, Saar M (eds): The pancreas. Boston, Black well Scientific. 1998;614-26.
Nealon WH, Walser E. Surgical management of complications associated with percutaneous and/or endoscopic management of pseudocyst of the pancreas. Ann Surg. 2005;241:948-60.
Khanna AK, Sathyendra K, Tiwary, Kumar P. Pancreatic pseudocyst: Therapeutic diemma. Int J Inflam. 2012;2012:1-7.
WilliamsNS, Bulstrode CJ, Connell PR. The pancreas. Bailey & love short practice of surgery. CRC Press. 2013;1118-9.
Imrie CW. Epidemiology, clinical presentation and behaviour of acute pseudocysts. In, Bradley EL. Acute pancreatitis diagnosis and Therapy, New York, Raven Press. 1994:175-9.
Walt AJ, Bouwman DL, Weaver DW, Sachs RJ. The impact of technology on the management of pancreatic pseudocyst. 5th annual Samuel Jason Mixter Lecture. Arch Surg. 1990;125:759-63.
Pancreas club.com. Los Angeles: History of pancreas, pancreas club, Inc. c2012-13. Available at: https://pancreasclub.com/ home/ pancreas/.
Baron TH, Harewood GC, Morgan DE, Yates MR. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc. 2002;56:7-17.
Fischer EW, Anderson DK, Bell Jr.HR, Saliya AK, Brunicardi FC. Pancreas. In, Brunicardi FC. Schwartz-Principles Of Surgery, 9th edition, New York, The McGraw-Hill .,2010;1200-4.
Pitchumoni CS, Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol Clin North Am. 1999;28:615-39.
Egidio A, Shein M. Pancreatic pseudocysts: aproposed classification and its management implications. Br J Surg. 1991;78:981-4.