Pancreas Pseudocyst Treatment, Causes and Symptoms 
Pancreas Pseudocyst Treatment, Causes and Symptoms 

Understanding Pancreatic Pseudocyst and Wall of Pancreatic Necrosis

Today, we will discuss Pancreatic Pseudocyst or Wall of Pancreatic Necrosis, a condition in which fluid collects around the pancreas.

The Pancreas and Its Functions

Firstly, let’s understand what the pancreas is. The pancreas is a gland that secretes fluid, about 1-1.5 liters per day, containing enzymes that aid in food digestion. This fluid is secreted into the small intestine. Additionally, the pancreas secretes hormones. In some patients, there is swelling in the pancreas, known as Acute Pancreatitis or Chronic Pancreatic Disease.

Causes of Pancreatitis: Gallstones and Alcohol Consumption

The major causes of Acute Pancreatitis are gallstones and alcohol consumption, while alcohol consumption is the major cause of Chronic Pancreatic Disease.

When a patient suffers from Pancreatitis, it causes a blockage in the pancreas, leading to the accumulation of pancreatic juice around it. This situation is referred to as Acute Fluid Collection. Normally, the formation of the wall around this fluid occurs after 4 weeks, and after 4 weeks, it is known as Pancreatic Pseudocyst or

Wall of Pancreatic Necrosis.

Development and Resolution of Acute Fluid Collection

It is observed that in most cases of Acute Fluid Pancreas, it resolves on its own, but in some patients, it leads to the development of a Pancreatic Pseudocyst.

If a patient only has a fluid problem and no wall formation around the pancreas, we usually wait for 4-6 weeks for the wall to develop so that we can assist the patient.

This is because it is easier to assist the patient once the wall is formed. It is also observed that in normal cases, the fluid dries up on its own. However, if the patient is in a serious condition and other organs are also affected, we need to assist in draining the fluid collection.

Treatment Options for Pancreatic Pseudocyst

Once a pseudocyst forms, the treatment depends on its size and symptoms. If the size is more than 6cm and there are no symptoms, we simply follow up instead of providing treatment. However, if the size is above 6cm, it does not reduce on its own, and there are pseudocyst symptoms, we assist in treatment.

Patients suffering from a pseudocyst often complain of pain in the upper part of the stomach. The pain may increase after meals. Additionally, patients with a pseudocyst may experience pain, fever, and other symptoms if the cyst compresses other organs. Compression of the stomach or small intestine may cause vomiting, while compression of the gallbladder duct may lead to jaundice.

Three types of treatments for pseudocysts:

  • Endoscopy
  • Surgery
  • Insertion of a tube from the outside

If the pseudocyst is located in the stomach, duodenum, or nearby areas, we perform endoscopy to assist in treatment. During the endoscopy, we insert a stent between the pseudocyst and stomach. If there is solid tissue in the pseudocyst, a metal stent is inserted, whereas if there is only fluid, a plastic stent is used. Normally, after 6 weeks, we remove the metal stent after conducting MRCP (magnetic resonance cholangiopancreatography). If the pancreas duct is functioning properly, the stent can be removed. However, if there is a leakage in the pancreas, we insert the stent using ERCP (endoscopic retrograde cholangiopancreatography) to control the leakage. After successfully controlling the leakage, the stent can be removed. If the leakage is uncontrollable, we can leave the plastic stent in place for long-term use, as it is safe.

If the pseudocyst is not near the stomach or small intestine, endoscopy cannot be used for treatment. In such cases, we opt for surgery or insert a half tube into the pseudocyst while leaving the remaining portion outside, allowing complete removal of the fluid.

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