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Pancreatic pseudocyst

Pancreatitis - pseudocyst

A pancreatic pseudocyst is a fluid-filled sac in the abdomen that arises from the pancreas. It may also contain tissue from the pancreas, enzymes, and blood.

Causes

The pancreas is an organ located behind the stomach. It produces chemicals (called enzymes) needed to digest food. It also produces the hormones insulin and glucagon.

Pancreatic pseudocysts most often develop after an episode of severe pancreatitis. Pancreatitis happens when your pancreas gets inflamed. There are many causes of this problem.

This problem may sometimes occur:

  • In someone with long-term (chronic) swelling of the pancreas (pancreatitis), most often due to alcohol abuse
  • After trauma to the belly, more often in children

The pseudocyst happens when the ducts (tubes) in the pancreas are damaged and fluid with enzymes cannot drain.

Symptoms

Symptoms can occur within days to months after an attack of pancreatitis. They include:

  • Bloating of the abdomen
  • Constant pain or deep ache in the abdomen, which may also be felt in the back
  • Nausea and vomiting
  • Loss of appetite
  • Difficulty eating and digesting food

Exams and Tests

The health care provider may feel your abdomen for a pseudocyst. It will feel like a lump in the middle or left upper abdomen.

Tests that may help detect pancreatic pseudocyst include:

Treatment

Treatment depends on the size of the pseudocyst and whether it is causing symptoms. Many pseudocysts go away on their own. Those that remain for more than 6 weeks and are larger than 5 centimeters (about 2 inches) in diameter often need treatment.

Possible treatments include:

  • Drainage through the skin using a needle, most often guided by a CT scan.
  • Endoscopic-assisted drainage using an endoscope. In this, a tube containing a camera and a light is passed down into the stomach)
  • Surgical drainage of the pseudocyst. A connection is made between the cyst and the stomach or small intestine. This may be done using a laparoscope.

Outlook (Prognosis)

The outcome is generally good with treatment. It is important to make sure that it is not a pancreatic cancer that starts in a cyst, which has a worse outcome.

Possible Complications

Complications may include:

  • A pancreatic abscess can develop if the pseudocyst becomes infected.
  • The pseudocyst can break open (rupture). This can be a serious complication because shock and excess bleeding (hemorrhage) may develop.
  • The pseudocyst may press down on (compress) nearby organs.

When to Contact a Medical Professional

If you are known to have a pseudocyst, rupture of the pseudocyst is a medical emergency. Go to the emergency room or call the local emergency number (such as 911) if you develop symptoms of bleeding or shock, such as:

Prevention

The way to prevent pancreatic pseudocysts is by preventing pancreatitis. If pancreatitis is caused by gallstones, the provider will perform surgery to remove the gallbladder (cholecystectomy).

When pancreatitis occurs due to alcohol abuse, you must stop drinking alcohol to prevent future attacks.

When pancreatitis occurs due to high blood triglycerides, this condition should be treated.

References

Forsmark CE. Pancreatitis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 135.

Martin MJ, Brown CVR. Management of pancreatic pseudocyst. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:525-536.

Vege SS. Acute pancreatitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 58.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • Pancreatic pseudocyst - CT scan

    Pancreatic pseudocyst - CT scan - illustration

    A CT scan of the upper abdomen showing a pseudocyst in the corpus, or tail, of the pancreas.

    Pancreatic pseudocyst - CT scan

    illustration

  • Pancreas

    Pancreas - illustration

    The pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.

    Pancreas

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Pancreatic pseudocyst - CT scan

      Pancreatic pseudocyst - CT scan - illustration

      A CT scan of the upper abdomen showing a pseudocyst in the corpus, or tail, of the pancreas.

      Pancreatic pseudocyst - CT scan

      illustration

    • Pancreas

      Pancreas - illustration

      The pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.

      Pancreas

      illustration


     

    Review Date: 10/25/2021

    Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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