Multiple Pancreatic Pseudocyst Disease

Abstract

In an effort to determine the incidence of multiple pseudocyst disease and establish the optimal approach to this problem, the records of 91 consecutive patients diagnosed during a 36-month period as having pancreatic pseudocyst disease by sonography or computerized tomographic scanning were reviewed. Thirteen patients (14.3%) had multiple cysts; all received sonograms and six had CT scans. The combined false negative and false positive rate with sonography was 9%. Spontaneous resolution occurred involving five cysts (18%) up to 6.5 cm in size. The diagnosis of cyst multiplicity was confirmed at operation in seven cases; two of the seven operations were excisional and the remaining patients received drainage procedures. There were no operative deaths; complications included one patient who required chronic enzyme replacement therapy after excision and another patient who developed a subphrenic abscess after attempted percutaneous drainage. The incidence of multiple pseudocyst disease in our series is just over 14%. The possibility of multiplicity should be carefully investigated in each patient with pseudocyst disease. In light of the rate of spontaneous resolution, not all patients with multiple pseudocysts may require operative therapy. Because of the 7.7% false negative diagnoses with sonography, CT scanning is especially helpful when the diagnosis of multiple pseudocysts is suspected or in preoperative preparation of pseudocyst drainage. If an operation becomes necessary, a drainage procedure rather than excision should be used whenever possible to maximize gland salvage.

Pancreatic pseudocyst in the left hepatic lobe: A report of two cases

“…Pank-eatic secretions containing proteolytic enzymes form pseudocysts mostly near the Dancreas. but thev can occur at anv site within FIG, 4, The third scan on October 2, demonstrating a large cystic lesion in the left lobe, the abdomen, even in the mediastinum (71, and they can be multiple (8). If fluid leaks from the posterior part of this gland or from its tail, the anterior pararenal space is filled first.…”

Review of general surgery 1984–85

“…Much, too, can be learned about the natural history of this condition. Goulet et al (1984), for example, were able to show that, of 91 cases of pseudocyst, no less than 13 (14.3%) were multiple on sonography; interestingly, all of these were alcoholic in origin. Ofparticular interest was the fact that, in five cases, all of which were small cysts up to 6.5 cm in diameter, spontaneous resolution occurred on serial scanning.…”

Pancreatic Pseudocyst with Gastric Outlet Obstruction: A Case Report and Literature Review

“…Plain abdominal radiography may show a soft tissue mass displacing or compressing surrounding viscera such as stomach, duodenum or transverse colon. Pseudocysts on computed tomography appear as low attenuated homogeneous lesions within or adjacent to the pancreas along with the presence of a well defined, nonepithelial, fibrous wall which may enhance with the addition of contrast 9 . Endoscopic retrograde cholangiopancreatography (ERCP) may reveal a partially or completely obstructed pancreatic duct due to either ductal fibrosis or extrinsic compression by the pseudocyst.…”