Pancreatic Pseudocysts Clinical Presentation

Updated: Nov 21, 2016
  • Author: Louis R Lambiase, MD, MHA; Chief Editor: BS Anand, MD  more...
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Presentation

History

No specific set of symptoms is pathognomic of pseudocysts; however, consider the possibility of a pseudocyst in a patient who has persistent abdominal pain, anorexia, or an abdominal mass after an episode of pancreatitis.

Rarely, patients present with jaundice or sepsis from an infected pseudocyst.

Pleural effusion is also a common finding.

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Physical Examination

The sensitivity of physical examination findings is limited. Patients very frequently have a tender abdomen. Patients occasionally have a palpable mass in the abdomen.

Peritoneal signs suggest rupture of the cyst or infection.

Other possible findings include the following:

  • Fever
  • Scleral icterus
  • Pleural effusion
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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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