Pancreatic Pseudocysts Follow-up

  • Author: Louis R Lambiase, MD, MHA; Chief Editor: Julian Katz, MD   more...
 
Updated: Nov 17, 2011
 

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.
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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.
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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%.
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Patient Education

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Contributor Information and Disclosures
Author

Louis R Lambiase, MD, MHA  Professor of Medicine, University of Tennessee College of Medicine Chattanooga; Chief, Division of Gastroenterology, University of Tennessee Chattanooga Unit; Assistant Dean for Clinical Affairs, University of Tennessee College of Medicine Chattanooga

Louis R Lambiase, MD, MHA is a member of the following medical societies: American Gastroenterological Association, American Pancreatic Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

David Greenwald, MD  Associate Professor of Clinical Medicine, Fellowship Program Director, 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, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of 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

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Three views of a pancreatic pseudocyst noted during endoscopic ultrasound. The concentric rings in the center of the images are the ultrasound transducer in the stomach. The cyst is observed as the large hypoechoic structure adjacent to the transducer.
These photographs show the endoscopic view of transpapillary pseudocyst drainage in a patient with pancreas divisum and a pseudocyst that communicates with the pancreatic duct. The image on the right shows the ampullary area. The middle image shows a wire placed in the minor papilla into the dorsal pancreatic duct. The left image shows a stent in place in the minor papilla.
 
 
 
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