Pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders. Their management demands the co-operation of surgeons, radiologists and gastroenterologists. Historically, they have been treated either conservatively or surgically, with acceptable rates of complications and recurrence. However, recent advances in radiology and endoscopy, have leaded physicians to implement percutaneous and endoscopic drainage (ED) into their treatment algorithms. Moreover, laparoscopic surgery, with its advantages, has become an attractive alternative choice when surgical drainage (SD) is required. The aim of this review is to summarize the main diagnostic and therapeutic tools in the management of pseudocysts and to present the main studies that compare the three different types of pseudocyst drainage.

Intrauterine pressure was measured, at the time of diagnostic amniocentesis or cordocentesis, in 200 pregnancies at 10–38 weeks’ gestation. Mean pressure decreased exponentially with gestation from 9 mm Hg at 10 weeks reaching a plateau of 5 mm Hg at 30 weeks. These findings are compatible with Laplace’s law of pressure in spheroids.

Severe twin-to-twin transfusion syndrome presenting before 28 weeks’ gestation is associated with a high neonatal mortality and morbidity due to polyhydramnios-related very premature delivery or intrauterine death of one or both twins. Management options include serial amniodrainages or laser coagulation of the intertwin placental anastomoses; however, early antenatal prognostic factors are lacking. Serial amniocenteses were performed in 9 pregnancies with twin-to-twin transfusion syndrome presenting with second-trimester polyhydramnios, and serial measurements of amniotic fluid pressure were made. Although in 8 cases the pre-drainage pressure was above the 95th centile of the normal range for singleton pregnancies, the pressures were lower in the pregnancies resulting in two livebirths than in the cases where one or both babies died. This study suggests that patients presenting with intra-amniotic pressure > 17 mm Hg cannot be safely managed by serial amniodrainages.

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