What is it?
These are liquid collections with a fibrous wall, which may or may not communicate with the pancreatic duct system. These liquid formations develop outside the pancreas mostly as a result of a previous episode of acute pancreatitis, or in the context of chronic pancreatitis. It is important not to confuse a pseudocyst with a cystic tumor, because the appearance can be very similar, but the treatment very different.
Which are the symptoms?
They are often asymptomatic, that is, they do not cause discomfort. Sometimes they may cause one or more of the following symptoms, due to compression on surrounding organs:
- nausea or vomiting, if the pseudocyst compresses the stomach or duodenum;
- jaundice (i.e., a yellow color of the skin and eyes), if the pseudocyst compresses the choledoch;
- pain, usually not very intense, referred as a weight to the upper abdomen;
- fever or sharp pain, in case of flare-ups
How is it diagnosed?
A pseudocyst should not be confused with a cystic tumor, because the treatment of the two diseases is quite different. The finding of a pancreatic or peripancreatic fluid collection when the patient has chronic pancreatitis, or has had acute pancreatitis, is almost certainly an expression of a pseudocyst. In contrast, when a liquid collection is found in a patient who has no previous history of pancreatic disease, it may be the expression of a cystic tumor of the pancreas.
- Blood tests are not helpful.
- Instrumental examinations that may provide useful information in the presence of a suspected pseudocyst are CT and/or MRI (magnetic resonance imaging) and echendoscopy. In case of diagnostic doubt, the ecoendoscopy is particularly indicated, both for the evaluation of the walls of the cyst, and because it allows to take fluid for specific analysis.
How is it treated?
Pseudocysts, if asymptomatic, do not require therapy, but only monitoring over time. If, on the other hand, they are symptomatic or particularly voluminous, they must be treated with surgery or an endoscopic procedure. In the vast majority of cases, the simple emptying of the cyst with a puncture is not sufficient, since the pseudocyst tends to reform. The surgical intervention is the pseudocyst-dyjunostomy, which consists in connecting, permanently, the pseudocyst to an intestinal loop.
Where do we treat it?
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