From the Guidelines
Pancreatic pseudocysts are primarily caused by acute or chronic pancreatitis, with alcohol abuse and gallstones being the most common underlying factors, as supported by the most recent and highest quality study 1. The formation of pancreatic pseudocysts is a complex process that involves the damage of pancreatic ducts, allowing pancreatic enzymes and inflammatory fluid to leak and become encapsulated by fibrous tissue.
- Key factors that contribute to the development of pancreatic pseudocysts include:
- Acute or chronic pancreatitis
- Alcohol abuse
- Gallstones
- Trauma to the pancreas
- Pancreatic tumors that obstruct pancreatic ducts The leaked pancreatic enzymes are particularly problematic as they can digest surrounding tissues, triggering an inflammatory response that ultimately forms the pseudocyst wall.
- The formation process typically takes 4-6 weeks as the body attempts to wall off the leaked pancreatic secretions, as noted in the study 1. Patients with pseudocysts often present with persistent abdominal pain, nausea, vomiting, and occasionally a palpable abdominal mass if the pseudocyst is large enough.
- It is essential to note that the management of pancreatic pseudocysts depends on the size, symptoms, and complications, with EUS-guided drainage being the optimal approach in uncomplicated pseudocysts that are located adjacent to the stomach or duodenum, as recommended by the consensus guidelines 1.
From the Research
Causes of Pancreatic Pseudocyst
- Pancreatic pseudocysts are a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter 2, 3, 4, 5.
- The pathogenesis of pseudocysts depends on the etiology: in acute pancreatitis, enzyme-rich fluid and products of autodegradation accumulate; in chronic pancreatitis, the cyst results from an obstructed duct 5.
- Pancreatic pseudocysts can also arise as a complication of pancreatic trauma, including postsurgical trauma 6.
- The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications 4.
Risk Factors
- Persistent abdominal pain or consistently elevated levels of pancreatic enzymes may indicate the presence of a pancreatic pseudocyst 5.
- The incidence of pseudocysts is noted to be higher as a result of better diagnostic techniques, such as ultrasound and computed tomographic scanning 5.
- Nearly one third of pancreatic pseudocysts resolve spontaneously, while others may require intervention 5.