Overview of Pancreatic Pseudocysts

What You Need to Know About Causes, Diagnosis, and Treatment

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Doctor assisting patient with severe abdominal pain
  PhotoAlto/Michele Constatini/PhotoAlto Agengy RF Collections/Getty Images

Pancreatic pseudocysts result from pancreatitis or from abdominal trauma. Small pseudocysts may not cause any problems at all, but others require medical intervention. Your doctor can help you decide what sort of treatment (if any) is needed.

What Is It?

The pancreas is an organ in the upper abdomen that produces many important hormones and digestive enzymes. When the pancreas is injured in some way, some of these digestive enzymes may leak from specialized ducts into the main portion of the pancreas. These may happen from injury or from internal inflammation of the pancreas. If these leaky enzymes are activated, they may damage part of the pancreas. This can lead to the development of something called a pancreatic pseudocyst.

A pancreatic pseudocyst is a kind of abnormal, fluid-filled sac found inside the pancreas. Unlike true medical “cysts,” pancreatic “pseudocysts” lack a specific covering of cells called epithelium—which can be viewed under a microscope. That is what distinguishes them from what medical professionals would call “true cysts” of the pancreas. Pancreatic pseudocysts can be grouped under a larger category with other cystic lesions of the pancreas. Some of those other types are cancerous, but pancreatic pseudocysts are not.

Causes

Pancreatic pseudocysts are a fairly common complication of pancreatitis, which is inflammation of the pancreas. They may arise from a case of “acute pancreatitis” in which symptoms come on suddenly and last for a few days. In other cases, pseudocysts may come from chronic pancreatitis, in which a person experiences exacerbations of symptoms repeatedly over months and years.

Rates of pseudocysts are higher for chronic pancreatitis: approximately 20 to 40 percent of patients with chronic pancreatitis have pseudocysts as a complication. Pancreatic pseudocysts can also occur from trauma to the area, such as from a car accident.

Pancreatitis itself has various potential causes. Some of these are:

People who have chronic pancreatitis from alcohol abuse may have the highest risk of pancreatic pseudocysts.

Symptoms

A pancreatic pseudocyst might cause symptoms like the following:

  • Abdominal pain
  • Nausea and vomiting
  • Sensation of fullness
  • Sensation of a mass in the belly (often painful to touch)

Occasionally pancreatic pseudocysts can cause significant complications. People with pseudocysts might have symptoms like fever if the cyst becomes infected. Rarely, jaundice (yellowing of the skin) may occur if the pseudocyst is blocking a bile duct. If a pseudocyst ruptures, it can cause quite serious problems, like dangerously low blood pressure and reduced consciousness. It’s very important that healthcare providers be aware of these possible symptoms from complications.

However, sometimes people with pancreatic pseudocysts don’t have any symptoms at all. These people might first learn that they have a pancreatic pseudocyst after having an imaging test done for another reason.

Almost always, patients with a pancreatic pseudocyst have previously experienced symptoms of acute or chronic pancreatitis. A very common symptom of pancreatitis is upper abdominal pain. This pain may radiate to the back, and it may be worse after eating. Other possible symptoms of pancreatitis include:

  • Nausea and vomiting
  • Fever
  • Weight loss
  • Smelly stool

Diagnosis

Pancreatic pseudocysts are diagnosed more often than they used to be, probably because of improved diagnostic techniques. Diagnosis requires a medical history, physical exam, imaging tests, and sometimes laboratory blood tests.

Pancreatic pseudocysts need to be distinguished from other lesions that can have a similar appearance. For example, some types of pancreatic cancer might appear on an imaging test as a kind of cyst.

Pancreatic pseudocysts are not cancerous, but during diagnosis, your doctor might need to make sure that you have a pseudocyst and not a cyst from cancer. Usually, imaging techniques are enough to distinguish pseudocysts from a possible lesion, but it some cases your doctor might need to take a portion of the cyst or cyst fluid to analyze.

Diagnosis may involve a number of different imaging tests. You probably won’t need all of these tests, but some potential options are:

  • Ultrasound of the abdomen
  • CT (computed tomography)
  • Endoscopic ultrasound
  • MRI (magnetic resonance imaging) with MRCP (magnetic resonance cholangiopancreatography)
  • ERCP (endoscopic retrograde cholangiopancreatography)

Treatment

Treatment of your pancreatic pseudocyst varies based on the specific medical situation. Some pancreatic pseudocysts go away without any medical intervention. This might happen within four to six weeks of an episode of acute pancreatitis. This is also more likely to occur if the pancreatic pseudocyst is small. Around half of pancreatic pseudocysts don’t require any direct medical intervention to go away.

Doctors will often recommend waiting and observing if the pseudocyst is less than about five centimeters, and if the person doesn’t have medical complications from the cyst. These people may still need supportive treatments, like intravenous fluids, anti-nausea drugs, and pain medication.

However, people with larger cysts or cysts causing major problems need prompt treatment. For example, you are likely to need treatment if any of the following apply to you:

  • Compression of a large blood vessel
  • Blockage of the gastric outlet
  • Blockage of a bile duct
  • Infection of the pseudocyst
  • Hemorrhage into the pseudocyst
  • Gastrointestinal bleeding
  • Significant symptoms from the pseudocyst

You may also need treatment if your pseudocyst hasn’t gone away after several weeks of observation. Traditionally, patients who had pancreatic pseudocysts that needed treatment had surgery. Surgery is still an important option for some people, and newer minimally invasive surgeries are also available.

Some people may qualify for other interventions that can be used to drain the pseudocyst without surgery. Percutaneous drainage of a pseudocyst is another option for some patients. In this procedure, a needle is inserted through the skin and into the pseudocyst, using the help of specialized medical imaging techniques.

Another option is endoscope drainage of the pancreatic pseudocyst. In this scenario, the doctor guides a thin, flexible tool (an endoscope) down your throat. The endoscope contains ultrasound equipment to provide imaging of the pseudocyst. The endoscope and other tools are used to drain the pseudocyst.

Neither of these methods is always successful in draining pseudocysts. You might eventually need surgery if these other methods don’t initially work for you, or if your pseudocyst comes back.

A Word From Verywell

Not everyone needs treatment for pancreatic pseudocysts. They may not cause any symptoms at all, or they may cause very significant complications, like from a ruptured cyst. If you decide to see if your pseudocyst goes away without treatment, make sure you know the symptoms of possible complications. That way, you can get help right away if you need it. Don’t be afraid to ask for all the information you need from your healthcare team. Together, you can work to make the best management decision for you.

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