Pseudocyst formation is one of the complications of chronic pancreatitis. The diagnosis of pseudocyst is usually done performing a ultrasound scan. The management of pseudo cyst occurs in a sequential manner.
- The initial management of all pseudocysts is conservative management. This is because some pseudocysts can disappear spontaneously. Also, the cysts should mature enough to perform any procedures. The maturation of the cyst usually take 6 weeks. Therefore, the patients with pseudocysts are reviewed in 6 months. The size of the tumor predicts the possibilities of disappearing. If the cyst is less than 6 cm wide, there is more chance that it will regress spontaneously. But, if it is more than 6 cm in size, it will persist more often.
- After 6 weeks another ultrasound scan is done. If the scan shows the persistence of the cyst, it is removed therapeutically. Several methods are available to do this. They are,
- Ultrasound guided drainage -
This is a minimal invasive method, but the cyst can recur later some time. Therefore, it is not the ideal way of treating pseudo-cysts.
- Open cystogastrostomy
In open cystogastrostomy, the abdomen is opened and the anterior and the posterior walls are opened. Then the cyst is also opened and the opening is sutured to the posterior opening of the stomach. The cyst contents will gradually drain in to the stomach and ultimately the cyst will disappear.
- Laparoscopic cystogastrostomy
In laparoscopic procedures, there is no need of opening the abdomen by using a long incision.
- Endoscopic cystogastrostomy
This is performed by an endoscope send through the mouth. Endoscopic cystogstrostomy is better because it only divides the posterior wall of the stomach.
Chronic pancreatitis is a disease with a lot of morbidity. Managing each of these morbidities is important when managing a patient with chronic pancreatitis.
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