Implications of diagnostic ultrasound in the surgical management of pancreatic pseudocysts

Abstract

Twenty-five consecutive patients with a clinical diagnosis of pancreatic pseudocyst supported by history, an abdominal mass or fullness, elevated serum amylase level, and confirmatory upper gastrointestinal series underwent preoperative examination by ultrasound. On thirteen occasions the ultrasonic configuration of a cyst was present in agreement with the clinical impression. Subsequent exploration or autopsy confirmed the presence of the cyst in ten instances, the remaining patients not coming to exploration. On thirteen other occasions, however, solid tissue was predicted by ultrasound in disagreement with the clinical impression. Nine of these patients came to exploration or autopsy, the ultrasound diagnosis being confirmed in eight. There was one false-negative result. In the eight patients with confirmed diagnoses of solid tissue clinically mimicking pseudocyst but correctly predicted by ultrasound, the mass consisted of peripancreatitic edema. This condition would appear to be more frequent than is generally realized. Unnecessary exploration can be avoided in these patients. The adjunctive uses of this technic in obtaining either natural history or postoperative information are discussed.