An observational study on complications and management of pseudo cysts of pancreas-In a tertiary care hospital

Abstract

Pancreatic pseudo cysts can occur as a complication of acute or chronic pancreatitis. Understanding of pseudo cysts has changed with times due to advancement in radiology and introduction of new treatment modalities. This study was done to access clinical features and various managements for pseudocyst in a tertiary care hospital. Methods: It is a prospective study of 20 adult patients admitted in tertiary care centre Surabhi Institute of Medical Sciences, Siddipet, Telangana, India from November 2018 to June 2019. Results: Pseudo cysts are more common in males. The commonest etiology associated was chronic pancreatitis with prevalence of 50%. Most of the cases of pseudo cysts of the pancreas due to acute pancreatitis. Ultrasound was the basic radiological investigation done in all patients followed by CECT abdomen. The commonest presentation is upper abdominal pain with upper abdominal mass. All cases we have confirmed that the cyst wall is deficient of epithelium by HPE. Internal drainage was done in most of the patients. Post drainage complications included infection which was managed by antibiotics and endoscopic drainage in case of recollection. Pain was most important post-operative complication. Infection was the common complication and mortality is nill. Endoscopic drainage is being preferred as it is less invasive, has a high long term success rate, and has shorter duration of hospital stay and more patient comfort. Conclusions: Pseudo cyst of pancreas is most commonly seen in males probably because of chronic pancreatitis. Clinical presentation can be varied, with pain abdomen being the most common complaint followed by, nausea vomiting. Initial management consists of supportive care and if the symptoms persist and complications develop surgical drainage was the most common management modality. Newer modalities of treatments like cystogastrostomy have an added advantage of lesser pain, shorter duration of hospital stay and recurrence. External drainage was done in 6 cases. The present study concluded that conservational approach and ultra sound guided external drainage are better for pseudo cysts with acute pancreatitis and traumatic etiology.