RT Book, Section
A1 Ellison, E. Christopher
A1 Zollinger, Robert M.
SR Print(0)
ID 1127273556
T1 DRAINAGE OF CYST OR PSEUDOCYST OF THE PANCREAS
T2 Zollinger's Atlas of Surgical Operations, 10e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179755-9
LK accesssurgery.mhmedical.com/content.aspx?aid=1127273556
RD 2024/04/19
AB Pseudocysts  of  the  pancreas  are  not  an  uncommon  sequela  of  acute  pancreatitis,  chronic  pancreatitis,  and  blunt  abdominal  trauma  with  resultant  traumatic  pancreatitis.  Pancreatic  pseudocysts  should  be  suspected  when  the  serum  amylase  remains  elevated  after  apparently  satisfactory  response  to  treatment  of  the  acute  episode.  However,  the  serum  amylase  may  be  normal,  and  quantitative  urinary  amylases  may  establish  the  diagnosis.  Blood  calcium  levels  should  be  followed  during  severe  episodes.  A  palpable  mass  can  usually  be  detected  in  the  upper  abdomen,  most  frequently  in  the  mid-epigastrium  or  the  left  upper  quadrant.  These  cysts  do  not  have  an  epithelial  lining  as  do  the  true  pancreatic  cysts.  They  are  most  commonly  found  in  the  body  and  tail  of  the  pancreas  but  also  may  be  found  in  the  neck  and  head  of  the  pancreas.  Ultrasonography,  computerized  tomographic  scans,  and  retrograde  cannulation  of  the  pancreatic  duct  with  injection  of  dye  and  x-ray  opacification  (endoscopic  retrograde  cholangiopancreatography  or  ERCP)  may  demonstrate  a  pseudocyst.  Films  of  the  chest  and  abdomen  may  demonstrate  elevation  of  the  left  hemidiaphragm  with  or  without  basilar  atelectasis  or  pleural  effusion.  Treatment  of  cysts  that  do  not  regress  spontaneously  consists  most  commonly  of  internal  drainage  via  the  stomach,  duodenum,  or  jejunum.  External  tube  drainage  with  subsequent  fistula  may  be  rarely  indicated.  Alternatively,  some  radiologists  may  drain  mature  pseudocysts  attached  to  the  posterior  wall  of  the  stomach  using  computerized  axial  tomography.  A  transgastric  needle  and  then  catheter  is  introduced  via  a  gastrostomy  usually  created  by  the  percutaneous  endoscopic  gastrostomy  technique  (Chapter  18).