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The pancreas is a spongy, leaf-shaped gland in the abdomen that is part of the endocrine system. It is about 6 inches long and 2 inches wide. It lies in the back of the abdomen, behind your stomach and small intestine. One of the functions of the pancreas is to make enzymes (digestive juices) that are released into your intestines and allow you to break down and absorb nutrients from your food. Injury to the pancreas, either from pancreatitis or physical trauma, can cause these digestive juices to leak out around the pancreas instead of flowing into the intestine as they are supposed to. The body has the ability to produce a wall or capsule around this fluid to protect itself from damage by these fluids. When this happens, the resulting collection of walled-off pancreatic fluid is “false” cyst called a pancreatic pseudocyst.
The most common cause of a pancreatic pseudocyst is a previous episode of acute pancreatitis. Acute pancreatitis can have many different causes but the most common is gallstones. Inflammation of the pancreas during an episode of pancreatitis can cause the pancreas to leak pancreatic juice out around the pancreas. With time, the body will wall off this fluid collection by forming a capsule around it, which we call a pancreatic pseudocyst.
Most pancreatic pseudocysts are late results of an episode of acute pancreatitis. Acute pancreatitis typically presents with severe upper abdominal pain that can radiate to the back. It may be several days to weeks after the episode of pancreatitis that patients will have symptoms of abdominal pain or fullness after eating. This is often the result of a large pancreatic pseudocyst that is occupying space in the patients upper abdomen near the stomach and making it difficult to eat even small amounts of food without feeling full. Other symptoms of pancreatic pseudocysts can be the result of the cyst pushing on, or eroding into other organs.
The diagnosis of pancreatic pseudocysts can often be made from the history of a recent episode of acute pancreatitis as well as imaging, such as a CT scan, that shows a fluid collection in the abdomen. Occasionally it is necessary to do a needle biopsy for definitive diagnosis.
Many pseudocysts resolve on their own with time. Occasionally, the pseudocyst is so large that it does not resolve on its own. Large, symptomatic pseudocysts can usually be managed endoscopically by draining the cyst into the stomach. On rare occasion it may be necessary to surgically drain the cyst. This can usually be done in a minimally invasive fashion.
As mentioned previously, surgery is rarely necessary for pancreatic pseudocysts. When indicated, surgery involves making a connection between the cyst and the intestine so that the cyst drains into the intestine and goes away. This can usually be done with a minimally invasive surgery. Ask your surgeon for specific details if surgery is recommended.