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Management of pancreatic pseudocysts

The American Journal of Surgery
Publication Date
DOI: 10.1016/0002-9610(72)90335-2
  • Medicine


Abstract Over a ten year period a total of thirty-four patients with forty-four pseudocysts were treated. Thirty-two patients required operation, whereas in two the cyst resolved spontaneously. In eight patients acute cysts failed to respond to intensive medical management and required external drainage to control the course of the disease. All of the pancreatic fistulas which were produced by this maneuver closed spontaneously. In twenty-four patients acute symptoms related to the cysts were lessened on conservative management, and operation was undertaken later to correct a persistent mass or to control chronic abdominal pain and tenderness. The method of internal drainage varied depending upon the size and location of the cyst. Most cysts in the head of the gland were drained directly into the duodenum. Evidence is presented indicating that many of these cysts originate in the segment of gland which is drained by the duct of Santorini. Cysts in the body of the gland were treated by cystogastrostomy or retrograde drainage using a defunctionalized limb of jejunum. Those involving the tail were often resected along with the spleen. When resection was employed, the open end of the remaining pancreas was usually anastomosed to a defunctionalized limb of jejunum to avoid leakage of pancreatic secretions. The two major complications were pancreatic fistula (eight cases) and postoperative gastrointestinal hemorrhage (four cases). One death was directly attributable to a massive postoperative hemorrhage from cystogastrostomy. Of six deaths, three occurred in the immediate postoperative period, and two of these were related to hepatic insufficiency in alcoholic patients. Three late deaths occurred, two of which were caused by carcinoma of the pancreas which became evident when a pseudocyst developed as a consequence of duct obstruction. Results of treatment were difficult to assess because of the high proportion of pseudocysts which occurred in patients with alcohol-induced pancreatitis (twenty-eight of thirty-four). Poor results in this group often appeared to be related to persistent alcoholic excess. Conversely, good results were obtained in patients with biliary-induced pancreatitis, and in eight of the alcoholic patients who either stopped or curtailed their drinking. Based upon our experience, a high percentage of pseudocysts of the pancreas occur as a consequence of alcohol-induced pancreatitis. Although local problems such as pseudocyst or duct obstruction can be corrected surgically, success of therapy is heavily dependent upon control of the underlying alcoholism. It is imperative that such patients receive appropriate psychiatric support during and after their surgical care.

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