Introduction Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Diagnosis is usually accomplished by cross sectional imaging and cyst fluid analysis will help in differentiating pseudocyst from other cystic lesions of pancreas. Most of them resolve with supportive care but intervention is required if there are persistent symptoms or develop any complications.1 Our aim was to review the practice of pancreatic pseudocyst management in a DGH set up and to formulate a care pathway or protocol supported by good evidence base.
Methods Retrospective case notes review of patients diagnosed with pancreatic pseudocyst. Patients were identified by ICD classification based clinical coding database. Data collected includes patient demographics, aetiology of pancreatitis, size and number of cysts, diagnostic modalities used, associated symptoms and complications, indication for intervention and type of intervention used and follow-up strategy
Results 62 patients were diagnosed to have pancreatic pseudocyst in last 7 years. Median age 60 yrs (range 24–91 yrs), male to female ratio was 1.4:1. Total of 81% (n=50) had history of acute pancreatitis. Alcohol (n=32, 50%) was the commonest underlying aetiology. Abdominal pain was the commonest symptom (n=55, 89%) and 10% (n=6) were asymptomatic. CT scan was used as diagnostic modality in 90% (n=56) and USS in 74% (n=46). Total of 82% (n=51) had a single cyst where as 18% (n=11) had multiple. Average cyst size was 70 mm (range 10–270 mm). About 76% (45/59, three died) had follow-up scan and average duration of follow-up was 13 months. Of them, cyst got increased in size in 32% (n=15), decreased in size in 23% (n=11), no change in 28% (n=11) and got resolved in 17% (n=8). Total of 43% (n=23) had their symptoms resolved spontaneously without requiring any intervention. Complications were noted in 28 % (n=17, CBD obstruction-7, cyst infection-6, gastric/duodenal obstruction-3 and cyst rupture in 1). About 39% (n=24) required intervention because of persistent symptoms or due to complications. Persisting pain (n=18, 29%) and increase in cyst size (n=7, 11%) were the commonest indications. In 58% (n=14) endoscopic, 33%(n=8) percutaneous and 8%(2) required surgical drainage. Of those who had intervention, 79% (n=19) required once, 17% (n=4) twice and 4% (n=1) thrice. Overall 79 % (19/24) had symptoms resolved post intervention.
Conclusion Pancreatic pseudocysts were managed conservatively in more than half of the patients group. In nearly one fifth of patients spontaneous resolution of cysts were noted in follow-up scans. Those who required intervention, endoscopic method was the most common method used and many patients achieved good resolution of their symptoms.
Competing interests None declared.
References 1. Andren Sandenberg A, et al. JOP 2004;5:8–24.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.