Controversies in the management of pancreatic pseudocysts

Mullins, Richard J.; Malangoni, Mark A.; Bergamini, Thomas M.; Casey, Joseph M.; Richardson, J. David

doi:10.1016/s0002-9610(88)80275-7

Cited by 54 publications

(19 citation statements)

References 18 publications

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“…Pancreatic pseudocysts arising after acute pancreatitis can often be managed conservatively, whereas the thicker-walled pseudocysts arising after chronic pancreatitis frequently require drainage [26] . Pseudocysts which have not regressed or have increased in size may require surgical drainage [17] and a variety of different methods have been described including open/laparoscopic pancreaticocystgastrostomy or pancreaticocystjejunostomy [27] , percutaneous aspiration and drainage [28] or endoscopic transmural or transpapillary drainage [29] .…”

Section: Treatmentmentioning

confidence: 99%

Cystic Lesions of the Pancreas

et al. 2008

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Section: Treatmentmentioning

confidence: 99%

Cystic Lesions of the Pancreas

et al. 2008

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“…However, it is not routinely used due to the risk of postoperative bleeding or leakage of the anastomosis or abscess formation. On the other hand when the pseudocyst wall is firm and adherent to the stomach, cystogastrostomy can probably be performed safely [1, 13]. Drainage of an infected pseudocyst into a jejunal loop also seems feasible, but in the present series no cysts were drained into the small bowel and in the world literature little data are available.…”

Section: Discussionmentioning

confidence: 83%

Internal Drainage of Infected Pancreatic Pseudocysts: Safe or Sorry?

Boerma¹,

Gulik²,

Obertop³

et al. 1999

Dig Surg

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Background: External drainage is the traditional surgical therapy for infected pancreatic pseudocyst, although associated with high morbidity and mortality rates. In this study it was determined whether internal drainage is feasible with acceptable postoperative morbidity and recurrence rates. Methods: A retrospective comparison was made of the outcome of internal versus external drainage of infected pseudocysts in 15 patients. All patients were known to have a (sterile) pseudocyst and presented with symptoms suggestive of infection of the cyst, proven by positive cultures and Gram staining. Results: Internal drainage was performed in 8 and external drainage in 7 patients. Patient characteristics appeared comparable, as was the time of sterile cyst presence before infection occurred (6 and 9 weeks, respectively). No major complications occurred, although hospital stay was prolonged after external drainage due to development of pancreaticocutaneous fistulas along the drain tract in 4 patients. Enteric microorganisms were cultured in 11 patients, of whom 10 had undergone ERCP just prior to infection. During follow-up no pseudocyst recurred. Conclusion: Surgical internal drainage of an infected pseudocyst is safe and effective and, in selected patients, is first-choice treatment. ERCP seems to play an important role in the secondary infection of pseudocysts.

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“…Such patients (Group B) can be identified by a clinical history of recurrent abdominal symptoms, a palpable mass on admission, and a well-formed pseudocyst on ultrasonographic examination and CT scan. Characteristic CT findings in such patients have been described [1]. The mean interval between diagnosis and operation in these patients was 16.5 days.…”

Section: Discussionmentioning

confidence: 87%

“…A pancreatic pseudocyst is an extravasated collection of exocrine pancreatic fluid surrounded by a wall of granulation tissue and characteristically lacking an epithelial lining [1]. It is a relatively rare disease entity but one which presents significant problems in both diagnosis and management [2].…”

mentioning

confidence: 99%

Pancreatic Pseudocyst: A Review of 5 Years' Experience

Al-Sulaimani

Alam

1991

Ann Saudi Med

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This retrospective study reviews our five-year experience with the management of cases of pancreatic pseudocyst. The etiological pattern, clinical presentation, diagnostic methods, and therapeutic measures are described. Biliary pancreatitis was the leading cause in our series, accounting for 45% of the cases. The majority of patients (69%) presented with acute pancreatitis, and pseudocyst subsequently developed during hospitalization. Twenty-one percent presented with developed pancreatic pseudocyst associated with recurrent abdominal pain. No mass was palpable in 48% of the patients. Ultrasonography and computed tomographic (CT) scanning were the two most useful investigations, yielding correct diagnosis in 95% and 100% of the cases, respectively. The pseudocyst completely resolved in 24% of the patients. Patients who presented with acute pancreatitis were initially treated conservatively until the cyst was mature enough for surgical intervention. Those who presented with well-developed cysts were operated on much earlier, after a mean period of 16.5 days. Internal drainage was used in 52% of the patients. The main complications were chest infection (31%) and wound infection (9.5%). The overall mortality was 5%.SH Al-Sulaimani, MK Alam, Pancreatic Pseudocyst: A Review of 5 Years ' Experience. 1991; 11(4): 391-395

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Controversies in the management of pancreatic pseudocysts

Cited by 54 publications

References 18 publications

Cystic Lesions of the Pancreas

Cystic Lesions of the Pancreas

Internal Drainage of Infected Pancreatic Pseudocysts: Safe or Sorry?

Pancreatic Pseudocyst: A Review of 5 Years' Experience

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