What Is the Treatment for a Pancreatic Cyst?

Pancreatic cysts include true cysts, pseudocysts, and cystic tumors, which are caused by congenital or acquired factors. Due to cyst compression, intravesical cavity and / or pancreatic duct hypertension, patients may have clinical manifestations such as abdominal pain, digestive system symptoms, and abdominal masses. Due to parenchymal lesions of the pancreas, endocrine and extracrine insufficiency may occur. True cysts include congenital simple cysts, polycystic disease, dermoid cysts, retention cysts, etc. The inner wall of the cyst is covered with epithelium. Cystic tumors include cystic adenoma and cystic carcinoma. The cyst wall of a pseudocyst is composed of fibrous tissue and is not covered with epithelial tissue. Clinically, pancreatic cysts are the most common pseudocysts.

Basic Information

English name

pancreatic cyst

Visiting department

Hepatobiliary Surgery, General Surgery

Common locations

upper abdomen

Common causes

Pseudocysts are caused by pancreatitis and can also be caused by trauma

Common symptoms

Abdominal pain, digestive symptoms, abdominal mass, etc.

Causes of Pancreatic Cysts

According to the etiology of cyst formation, pseudopancreatic cysts are divided into:

1. Pseudocysts after inflammation: seen in acute pancreatitis and chronic pancreatitis.

2. Pseudocysts after trauma: seen in blunt trauma, penetrating trauma or surgical trauma.

3. Pseudocysts caused by tumors.

4. Parasitic pseudocysts: caused by roundworms or cysts.

Clinical manifestations of pancreatic cysts

A few pseudocysts are asymptomatic and found only on a B-ultrasound. In most cases, clinical symptoms are caused by cysts compressing adjacent organs and tissues. Abdominal pain occurs in 80% to 90% of patients. Most of the pain is in the upper abdomen, and the pain range is related to the location of the cyst, which often radiates to the back. With nausea, vomiting, and decreased appetite. Weight loss is seen in some cases. Fever is often low. Diarrhea and jaundice are rare. If the cyst oppresses the pylorus, it can lead to pyloric obstruction; oppression of the duodenum can cause duodenal stasis and high intestinal obstruction; compression of the common bile duct can cause obstructive jaundice; compression of the inferior vena cava causes symptoms of inferior vena cava obstruction and lower limb edema; The ureter can cause hydronephrosis and so on. Pancreatic pseudocysts within the mediastinum may have symptoms of heart, lung, and esophageal compression, chest pain, back pain, dysphagia, and jugular vein distension. If the pseudocyst extends to the left groin, scrotum, or rectal uterine crypt, etc., rectal and uterine compression symptoms may occur. On physical examination, most patients have a mass in the upper abdomen or left quarter. The mass is spherical, with a smooth surface and little nodularity, but it can have a sense of fluctuation, little mobility, and often tenderness.

Pancreatic cyst examination

Blood and stool tests

Few patients have increased serum amylase and blood sugar, and there are more fat particles in the stool.

2. Barium meal examination

The duodenal cuff is enlarged, and the stomach, duodenum, and transverse colon are compressed and displaced.

3. Type B ultrasound

Shows a spherical, smooth and clear lesion area, a dark area without light spots reflection, or an internal fistula formed between the cyst and the digestive tract.

4. Angiography

It can be seen that the blood vessels are in a birdcage-like compression phenomenon, and the capillaries are uniform and lightly stained around the pancreatic cysts or the internal fistula of cysts and blood vessels is seen.

5. Pancreas scan

⁷⁵ Se-methionine pancreas scintigraphy showed no aggregation.

6.CT

Low-density shadows with round, oval, and clear edges are visible, and the CT value is close to the density of water.

Pancreatic cyst diagnosis

Symptoms such as persistent upper abdomen, nausea and vomiting, weight loss, and fever appear after acute pancreatitis or pancreatic trauma, and the possibility of pseudopancreatic cyst formation should be considered first in abdominal crests and cystic mass. Timely inspection, combined with clinical imaging and other auxiliary examination results can make a diagnosis.

Pancreatic Cyst Treatment

Emergency surgery

When life-threatening cyst rupture, bleeding, secondary infection, etc., perform emergency external drainage surgery (incision drainage or bag suture), pay attention to water, electrolyte and systemic treatment. After the fistula is formed, another operation is performed.

2. Selective surgery

Two to four months after the formation of the pseudocyst, surgery was selected based on the degree and extent of the lesion. Pancreatic tail splenectomy can be performed in the tail of the pancreas; cyst and stomach anastomosis, cyst duodenal anastomosis, and cyst jejunum Roux-Y anastomosis are performed on the head and body of the pancreas. The anastomosis should be large enough to prevent reflux infection. When an internal fistula is present, the intestine should be cleaned before surgery, neomycin is administered orally, and vitamin K is injected intramuscularly.

True cysts are generally not tightly adhered to the surrounding tissues and are relatively easy to peel off. Part of the pancreas can also be removed with the cyst.