Cysts in the pancreas may occur in 15% of patients after acute pancreatitis (See Acute pancreatitis). In some cases, there may be no history of acute pancreatitis or trauma. Pseudocysts can also develop in the course of chronic pancreatitis. It is accepted that they are formed as a result of the accumulation of pancreatic fluid leaking into the pancreatic tissue as a result of damage to the pancreatic duct by being limited in a capsule. Cells in the capsule wall are composed of non-epithelial cells.
A period of at least 4 weeks is required for the capsule to strengthen with the connective tissue and form a pseudocyst. Since pseudocysts are associated with the pancreatic duct, pancreatic enzymes (amylase and lipase) are detected at high levels in the cyst fluid. Although sometimes they can reach the size to cover the entire pancreas, they are usually 2-8 cm in diameter. When serum amylase levels do not decrease to normal levels in patients with pancreatitis and abdominal pain continues, necessary investigations should be done considering that a pseudocyst may have developed.
Pseudocysts formed after acute pancreatitis regress spontaneously in the majority of patients (85%), usually within 6 weeks. In some cases, this improvement may take up to 2 years. Spontaneous resolution is very rare in cysts that do not disappear after 8 weeks. Pancreatic pseudocysts smaller than 4 cm usually disappear spontaneously. This probability is lower in cysts larger than 6 cm and those with chronic pancreatitis. In 40% of pseudocysts smaller than 6 cm, the cyst needs to be drained. Cases that develop pseudocysts after pancreatitis are followed up at regular intervals. In principle, it is recommended to monitor pseudocysts that do not cause pain, are not infected, and do not show signs of compression on adjacent organs.
Pseudocysts that do not regress spontaneously, cause complaints such as pain and swelling, or develop complications such as bleeding and infection, can be treated by evacuation (cyst drainage) by endoscopic, radiological and surgical methods. Pseudocysts can also cause other symptoms by pressing on organs adjacent to the pancreas. At least 4-6 weeks should be waited for the cyst wall to mature before drainage.
Endoscopic methods should be preferred because they are less invasive and have a low complication rate. In endoscopic methods, the cyst is mouthed to the stomach (transmural route, cystogastrostomy) or a catheter is inserted into the cyst through the pancreatic duct (transpapillary route), allowing the cyst fluid to drain into the stomach or intestine.
Surgical treatment is applied in cysts that cannot be drained by endoscopic method. In surgical evacuation, the cyst is emptied by mouthing it into the stomach or small intestine. In some cases, the liquid inside the pseudocysts can become infected and create a life-threatening picture. In this case, the cyst should be drained as soon as possible.