eMedicine Specialties > Gastroenterology > Pancreas

Pancreatic Pseudocysts: Follow-up

Author: Louis R Lambiase, MD, Associate Professor of Medicine, University of Florida College of Medicine; Chief, Division of Gastroenterology, Department of Internal Medicine, University of Florida Health Science Center/Jacksonville
Contributor Information and Disclosures

Updated: Mar 18, 2008

Follow-up

Further Outpatient Care

  • Patients who have endoscopically placed stents must be monitored via serial CT scans to observe resolution of the cyst. Stents may then be endoscopically removed after resolution.
  • Closely monitor patients with percutaneous drains for pain, infection, or catheter migration. Remove the drain when drainage ceases.

Complications

  • Bleeding is the most feared complication and is caused by the erosion of the pseudocyst into a vessel.
    • Consider the possibility of bleeding in any patient who has a sudden increase in abdominal pain coupled with a drop in hematocrit level or a change in vital signs.
    • Therapy is emergent surgery or angiography with embolization of the bleeding vessel.
    • Do not perform a percutaneous or endoscopic drainage procedure under any circumstances in patients with suspected bleeding into a pseudocyst.
  • Consider the possibility of infection of the pseudocyst in patients who develop fever or an elevated WBC count. Treat infection with antibiotics and urgent drainage.
  • GI obstruction, manifesting as nausea and vomiting, is an indication for drainage.
  • The pseudocyst can also rupture.
    • A controlled rupture into an enteric organ occasionally causes GI bleeding.
    • On rare occasions, a profound rupture into the peritoneal cavity causes peritonitis and death.

Prognosis

  • Most pseudocysts resolve without interference, and patients do well without intervention.
  • Outcome is much worse for patients who develop complications or who have the cyst drained. The presence of pancreatic necrosis is a poor prognostic sign.
  • The failure rate for drainage procedures is about 10%, the recurrence rate is about 15%, and the complication rate is 15-20%.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis of a cystic neoplasm of the pancreas and treating it as a pseudocyst
  • Failure to recognize and treat complications
 


More on Pancreatic Pseudocysts

Overview: Pancreatic Pseudocysts
Differential Diagnoses & Workup: Pancreatic Pseudocysts
Treatment & Medication: Pancreatic Pseudocysts
Follow-up: Pancreatic Pseudocysts
Multimedia: Pancreatic Pseudocysts
References
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References

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Further Reading

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Keywords

pancreatic fluid collections, organized necrosis of the pancreas, pancreatic cysts, pancreatitis, abdominal trauma, pancreatic ducts, persistent abdominal pain, anorexia, abdominal mass, jaundice, sepsis, pleural effusion, scleral icterus, percutaneous catheter drainage

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Contributor Information and Disclosures

Author

Louis R Lambiase, MD, Associate Professor of Medicine, University of Florida College of Medicine; Chief, Division of Gastroenterology, Department of Internal Medicine, University of Florida Health Science Center/Jacksonville
Louis R Lambiase, MD is a member of the following medical societies: American Gastroenterological Association, American Pancreatic Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

David Greenwald, MD, Fellowship Program Director, Associate Professor, Department of Medicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine
David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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