True statement about pseudocyst of pancreas is:
Ans: A (Contains a wall of fibrous connective tissue) Ref: Sabiston Textbook of Surgery, 19th Edition, pg. 1524-25Explanation:Pancreatic PseudocystsPancreatic pseudocysts occur in 5% to 15% of patients who have peripancreatic fluid collections after acute pancreatitis.By definition, the capsule of a pseudocyst is composed of collagen and granulation tissue and it is not lined by epithelium.The fibrotic reaction typically requires at least 4 to 8 weeks to develop.Clinical FeaturesUpto 50% develop symptomsAbdominal painEarly satietyNauseaWeight lossDiagnosisElevated pancreatic enzyme levels in plasma is suggestiveCT or MR1 can confirm the diagnosisEUS with FNA is indicated for patients in whom the diagnosis is not clearCyst fluid analysisHigh amylaseAbsence of mucinLow- carcinoembryonic antigen (CEA) levelsManagementAsympomatic PatientsOnly observation is indicated because spontaneous regression has been documented in upto 70% of asymptomatic patients.Factors favoring spontaneous regressionPseudocysts smaller than 4 cm in diameterLocated in the tailNo evidence of pancreatic duct obstruction or communication with the main pancreatic duct.Symptomatic PatientsManagement options areEndoscopic ManagementTransgastric/transduodenal endoscopic drainage - for pseudocysts in close contact (defined as <1 cm) with the stomach and duodenum.Transpapillary drainage can be attempted in pancreatic pseudocysts communicating with the main pancreatic duct.For pancreatic duct stricture is associated with a pancreatic pseudocyst, endoscopic dilation and stent placement are indicated.SurgeryIndicated for patients with pancreatic pseudo- cysts that cannot be treated with endoscopic techniques and patients who fail endoscopic treatment.Depends on the location of the cyst.Pancreatic pseudocysts closely attached to the stomach should be treated with a cyst-gastro- stomv.Pancreatic pseudocysts located in the head of the pancreas that are in close contact with the duodenum are treated with a cvstoduodeno- stomy.For pseudocysts are not in contact with the stomach or duodenum the surgical treatment is a roux-en-y cystojejunostomy.Percutaneous DrainagePercutaneous drainage is only indicated for septic patients secondary to pseudocyst infectionHigh incidence of external fistulaComplications of PseudocystBleedingPancreaticopleurul fistulaBile duct obstructionDuodenal obstructionRupture into the abdominal cavityInfection
Contains a wall of fibrous connective tissue
Develops immediately after acute pancreatitis
Requires laparotomy
Preceded by trauma in 90% cases
Pathophysiology - Acute Pancreatitis