Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Recent history of acute pancreatitis, pancreatic trauma, or known chronic pancreatitis• Epigastric mass and pain• Mild fever and leukocytosis• Persistent serum amylase elevation• Pancreatic cyst demonstrated by US or CT scan +++ Epidemiology + • Encapsulated collections of pancreatic secretions-Arise following acute pancreatitis or from chronic ductal obstruction (chronic pancreatitis) or acute ductal disruption (trauma)• The walls of a pseudocyst are formed by inflammatory fibrosis of the peritoneal, mesenteric, and serosal membranes, which limits spread of the pancreatic juice as the lesion develops• Pseudocysts develop in about 2% of cases of acute pancreatitis-The cysts are single in 85% of cases• Pseudocyst should be suspected when a patient with acute pancreatitis does not recover after 1 week of treatment or when, after improving for a time, symptoms return• Pseudocysts can contain collections of sterile or infected material +++ Symptoms and Signs + • Abdominal pain is most common• Fever• Weight loss• Jaundice, due to obstruction of the intrapancreatic segment of the bile duct• Palpable, tender mass in the epigastrium +++ Laboratory Findings + • Elevated serum amylase• Leukocytosis• Elevated bilirubin levels reflect biliary obstruction +++ Imaging Findings + • CT scan-Diagnostic study of choice-Size and shape of the cyst and its relationship to other viscera can be seen-A pancreatic duct obstruction may be found with chronic pancreatitis-A dilated common bile duct suggests biliary obstruction• US: May be useful to follow changes in size of an acute pseudocyst already imaged by CT scans• ERCP: Should be performed if there is obstruction or disruption of the pancreatic duct as these findings would require endoscopic or surgical treatment + • With wide use of sensitive imaging studies in the diagnosis of pancreatic disease, small asymptomatic pseudocysts are often demonstrated-The natural history of these subclinical lesions is benign-There is no indication for prophylactic surgical treatment• Pancreatic pseudocyst associated with ductal obstruction (chronic pancreatitis) or disruption (trauma) is unlikely to resolve without correction of the underlying defect +++ Rule Out + • Pancreatic abscess• Acute pancreatic phlegmon• Pancreatic adenocarcinoma• Pancreatic neoplastic cysts-Account for about 5% of all cases of cystic pancreatic masses-May be indistinguishable preoperatively from pseudocyst-Cyst wall must be biopsied to exclude neoplasia + • Serum amylase• Serum bilirubin• CBC• Abdominal CT• ERCP if indicated +++ When to Admit + • Severe symptoms• Infection + • Asymptomatic cysts may be observed; 40% will resolve within 8-12 weeks• Drainage options:-Internal (cystgastrostomy or jejunostomy)-External-Percutaneous (infected) +++ Surgery +++ Indications + • All symptomatic pseudocysts• Cysts > 5 cm that have not resolved ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth