Pseudocyst or inflammatory pancreatic fluid collection. A pancreatic fluid collection sometimes referred to as a pseudocyst is a collection of fluid and at times tissue that is usually a result of pancreatitis. A less common cause is trauma, such as a blow to the abdomen during a motor vehicle accident.
A pseudocyst (or false cyst because the wall is not lined by any specific cells, a characteristic of true cysts) is a more restrictive term that refers to inflammatory fluid collection alone without tissue. During severe pancreatitis attacks, a part of the pancreas may die due to temporary lack of blood supply. This results in pancreatic necrosis. When present, necrosis can present challenges as it often leads to infection of the pancreas fluid collection. Pancreatic fluid collections are usually located around the pancreas and adjacent to organs such as the stomach and small intestine.
Pancreatic fluid collections can grow to a large size and cause symptoms by blocking other organs. Symptoms can also be due to bleeding into the cyst, infection of the cyst contents, rupture of the cyst or due to spontaneous drainage of the fluid into other organs or structures. Typically larger cysts are more likely to cause symptoms. Symptoms most commonly reported are:
- Abdominal tenderness and/or pain especially with eating.
- Weight loss.
- Feeling full after eating little food.
- Nausea and vomiting.
- Fever with or without chills and night sweats.
- Yellowish skin and eyes (jaundice).
- Fluid buildup in the abdomen.
A pancreatic fluid collection that is not growing or causing symptoms may be watched and managed conservatively. Treatment or drainage of the cyst is reserved for fluid collections that cause symptoms. Modes of drainage of the cyst are:
- Endoscopy: an endoscopic ultrasound (EUS), flexible tube with a camera (endoscope) and ultrasound probe at the tip, is passed through your mouth to your stomach and small intestine. A hollow tube (metal or plastic stent) is advanced into the cyst to drain the cyst into the stomach or intestine. Multiple endoscopies may be necessary if necrotic tissue is present in the inflammatory fluid collection, to remove all the necrotic tissue.
- External drainage: drainage via a catheter (tube) placed through the skin under the guidance of a CT scan. The catheter is usually connected to a bag to collect the draining fluid.
- Surgery: to create a connection between the cyst and the stomach or small intestine to facilitate the drainage of the cyst. Necrosis removal can also be accomplished during surgery.
Symptoms of pancreatic pseudocysts can include abdominal pain, nausea and vomiting, and changes in bowel habits. However, many people with pancreatic pseudocysts do not have any symptoms.
Pancreatic pseudocysts are usually diagnosed with imaging tests, such as CT scan or MRI. A procedure called endoscopic ultrasound (EUS) may also be performed to get a closer look at the pseudocyst and confirm the diagnosis. EUS involves inserting a thin tube with an ultrasound probe into the digestive tract to get a close-up view of the pancreas.
Treatment for pancreatic pseudocysts depends on the size and location of the pseudocyst, as well as the person’s overall health. In some cases, a pancreatic pseudocyst may resolve on its own over time. However, if the pseudocyst is causing symptoms, or is infected, endoscopy may be necessary to drain the fluid. Surgery is rarely necessary.
Pancreatic pseudocysts are often a complication of pancreatitis, which is often caused by alcohol abuse or gallstones. Avoiding alcohol and getting regular check-ups for gallstones may help reduce the risk of developing pancreatic pseudocysts.
Pancreatic pseudocysts are not cancerous and do not have the potential to become cancerous.
Medications, such as pain relievers and anti-nausea drugs, may be used to manage symptoms associated with pancreatic pseudocysts. However, endoscopy is usually necessary to drain the fluid and decompress the pseudocyst. Surgery is rarely necessary.
Maintaining a healthy diet and avoiding alcohol may help manage pancreatic pseudocysts. It is also important to follow the treatment plan recommended by a healthcare provider and to seek medical attention if symptoms worsen.
It is possible for pancreatic pseudocysts to recur after treatment, especially if the underlying cause of the pseudocyst, such as pancreatitis, is not addressed.