Pancreatic Cysts & Pseudocysts
(Also Called 'Pancreatic Cysts and Pseudocysts')
What is a pancreas?
Your pancreas is a 6-inch gland located below your liver, between your
stomach and your spine. The pancreas is made up of 3 parts: a "head" that is
tucked into the duodenum (the upper part of the small intestine); a flattened,
longer "body;" and a "tail" that is connected to the spleen.
Your pancreas makes potent digestive enzymes and hormones that help manage
blood glucose (blood sugar). Normally, these enzymes and hormones do not become
active until they exit the pancreas and enter other parts of the body.
Your pancreas also produces bicarbonates that neutralize stomach acids. Small
ducts (tubes) move these fluids into a larger pancreatic duct, down into the
duodenum. The common bile duct also carries bile (a substance that breaks down
fats) from your liver and gall bladder through the head of the pancreas into
your small intestine.
What is pancreatitis?
An inflammation of the pancreas is called pancreatitis. Pancreatitis can
either be acute (a sudden, sharp, and/or severe attack) or chronic (recurring
and/or lasting for a long period of time). When the pancreas is inflamed,
digestive enzymes become activated while still inside the pancreas, which can
cause the pancreas to begin "digesting" its own tissues.
The two most common causes of pancreatitis are gallstones (bile that has
hardened into little pebble-like masses) and chronic, heavy alcohol use.
Pancreatitis can also result from certain diseases or injury. Pancreatic
pseudocysts can develop as a serious complication of pancreatitis.
What is a pancreatic cyst?
A pancreatic cyst is a closed sac lined with epithelium and located on or in
your pancreas. Pancreatic cysts contain a pool of pancreatic fluid or semisolid
matter made up of debris or destroyed tissue.
They can range from benign pseudocysts (see below) to malignant cysts
(cancerous and spreading.) The cause of a particular pancreatic cyst is often
unknown. Some pancreatic cysts result from certain rare diseases, such as von
Hippel-Lindau disease (a genetic disorder).
What is a pancreatic pseudocyst?
A pancreatic pseudocyst is a type of cyst that it is not contained inside an
enclosed sac of its own with an epithelium lining. Instead, the pseudocyst forms
within a cavity or space inside the pancreas and is surrounded by fibrous
tissue. Pancreatic pseudocysts do contain inflammatory pancreatic fluid
(particularly the digestive enzyme amalyse) or semisolid matter.
- Are health problems caused by acute or chronic pancreatitis.
- Are caused by a blockage in the pancreatic ductal system.
- Are round or oval in shape.
- Are the most common pancreatic cystic lesions (about 75% to 80% of all
pancreatic cystic lesions).
- Are benign (non-cancerous).
- Affect approximately 1 in 1,000 adults per year.
What are the symptoms of pancreatic cysts or pseudocysts?
Pancreatic cysts, including pseudocysts, can be asymptomatic (having no
obvious symptoms) or can produce moderate to severe symptoms. Symptoms may occur
within days to months following a pancreatitis attack. When present, the most
common symptoms include:
- Severe, persistent pain in the abdomen and sometimes the back
- Abdominal bloating
What are the complications of pancreatic cysts/pseudocysts?
Many complications can come from pancreatic cysts/pseudocysts, including:
- Infection, which can sometimes lead to pancreatic abscess
- Pseudocyst rupture (breaking open) or hemorrhage (bleeding), which can
happen without warning and which can be life-threatening
- Biliary complications, which can occur when a large cyst blocks the
common bile duct, causing skin, mucous membranes, and whites of the eyes to
appear yellow (obstructive jaundice)
- Portal hypertension, or high blood pressure of the splenic vein/portal
vein, which requires surgery
How are pancreatic cysts and pseudocysts diagnosed?
Pancreatic pseudocysts can be hard to diagnose because the symptoms can be
similar to various other diseases. Since the pancreas is located deep inside the
abdominal cavity, cross-sectional imaging is often used to locate and diagnose
pancreatic cysts and pseudocysts.
Testing may include:
- Transabdominal US (ultrasound), which uses sound waves to detect a
pancreatic pseudocyst, or gallstones that could potentially cause a pseudocyst.
- Abdominal CT (computed tomography) scan, which usually provides all the
diagnostic information necessary, and provides more detailed surrounding
anatomy and pathology information than ultrasound does.
- MRI (magnetic resonance imaging) and MRCP (magnetic resonance
cholangiopancreatography), though not typically used, provide sharper
imaging of fluids and debris in pseudocysts than CT scans do.
- EUS (endoscopic ultrasound) is usually a secondary test (following US,
CT, or MRI) to further evaluate a pancreatic cyst and/or to distinguish a
pancreatic pseudocyst from other types of cystic lesions. Analysis of fluid
obtained by the cyst via a fine needle is then used to differentiate between
types of cysts and pseudocysts.
- ERCP (endoscopic retrograde cholangiopancreatography) enables the doctor
to view the structure of the common bile duct, other bile ducts, and the
How are pancreatic cysts and pseudocysts treated?
Most pseudocysts resolve themselves without treatment, over time. However,
when symptoms become persistent, complications emerge, or cysts become larger
than 6 centimeters in size, drainage is indicated.
There are three methods of cyst drainage:
- Endoscopic drainage (as described above)
- Percutaneous catheter drainage, which uses hollow tube inserted into the
body to remove fluid
- Surgical drainage, either via open surgery or laparoscopic surgery
(using a laparoscope, a surgical tool that only requires a small incision)
Endoscopic drainage is gaining acceptance because it is less invasive, has
less risk of complications than open surgery, does not require an external
drain, and its long- term success rate is high.
What is the prognosis?
Pseudocysts should be treated due to potential serious risks. If a
complication causes the enzymes and toxins in the pseudocyst to enter the
bloodstream, the heart, lungs, kidneys, or other organs could be seriously
adversely affected. Some cysts require surgical removal.
In most cases, the prognosis is generally positive for people who undergo
treatment for pancreatic cysts and pseudocysts.
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