Clinicopathological features of Pseudocyst Pancreas and its Management: A Prospective and Retrospective Study

Dr Mahim Koshariya,Dr Agam Sharma,Dr M C Songra,Dr Brahmanand Gupta,Dr Jaiprakash Singour,Dr Tushar Suroshe

doi:10.17511/ijoso.2020.i06.01

Abstract

Background: Revised Atlanta Classification has veered a change in our understanding ofpseudocyst pancreas which mandates renewed inquiry into pseudocysts defined as per new criteria.The present study provides an overview of experience with Pseudocyst Pancreas for over a decade.Methodology: 100 cases of pseudocysts diagnosed over the last 10 years at GMC, Bhopal,conforming to the present definition were reviewed. Cysts with the inhomogeneous collection,debris, necrosis, or any other non-liquid component, specifically in those diagnosed before 2012were excluded. Relevant data were analyzed. Results: The majority were male (85%) in the agegroup of 40-50 years with alcohol-induced chronic pancreatitis (77%) being the most frequentetiology. Abdominal pain (40%), lump (30%), and abdominal tenderness (59%) were common atpresentation. 58% were in the Head of the pancreas, 29% in the Neck and Body, and 13% in theTail and surrounding areas. Mean cyst diameter was 8.6cm and volume 252cc. 85% were managedsurgically and 40% of those managed conservatively also needed surgical intervention eventuallydue to complications. History of chronic alcoholic pancreatitis, the large size of the cyst (≥6cm and≥60cc), and communication with the main pancreatic duct were highly predictive of surgicalintervention. Conclusion: Radiological characteristics along with the clinical picture may suggestappropriate intervention. Surgery remains the principal modality of treatment, with high successrates.

Highlights

Pancreatic pathologies include the diverse entities of pancreatic fluid collections and cystic pancreatic lesions of which the pseudocyst pancreas embodies an important component
Revised Atlanta Classification has veered a change in our understanding of pseudocyst pancreas which mandates renewed inquiry into pseudocysts defined as per new criteria
The present study provides an overview of experience with Pseudocyst Pancreas for over a decade

Summary

Introduction

Pancreatic pathologies include the diverse entities of pancreatic fluid collections and cystic pancreatic lesions of which the pseudocyst pancreas embodies an important component. The revised Atlanta classification in 2012 has improved standardized reporting and effective communication between radiologists and clinicians by the first categorization of the type of acute pancreatitis into necrotizing pancreatitis and interstitial edematous pancreatitis (IEP), based on the presence or absence of necrosis, respectively, and further identifying distinct pancreatic collection subtype according to the time elapsed since the onset of pancreatitis. Such precise description of pancreatitis pseudocysts can be defined as cystic collections after Interstitial Edematous Pancreatitis (IEP) in more than 4 weeks with a welldefined wall and absence of any solid component or necrotic debris [2]. Surgery remains the principal modality of treatment, with high success rates

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Results

Conclusion