Have you ever suffered from a condition called pancreatitis? When that happens, a fluid-filled sac can sometimes form around our pancreas. This is what we call a pancreatic pseudocyst. The name may sound a little scary, but once we know what it is, there's no need to panic.
What is a pancreatic pseudocyst?
Simply put, when your pancreas is damaged, for example, when you have pancreatitis, a fluid-filled sac called a pancreatic pseudocyst forms around it. Now look, our pancreas is an important organ located in the upper part of the stomach. It makes enzymes, or substances that help digest the food we eat. These enzymes travel as a liquid through the pancreatic duct into our small intestine.
However, when a severe condition such as pancreatitis occurs, this pancreatic duct can become damaged, causing the fluid containing digestive enzymes to leak out. This leaking fluid causes discomfort to the surrounding tissues. The body then forms a protective wall around the leak. This wall is made up of fibrous, scar-like tissue. That's what we call a pseudocyst.
What is the difference between a true cyst and a pseudocyst?
This is a very important point. A pancreatic pseudocyst is not a true cyst. Because it is not made up of the actual tissue of the pancreas itself. As I mentioned earlier, its wall is made up of fibrous scar tissue. The special type of cells called epithelial cells that are found in real pancreatic tissue are not in the walls of these pseudocysts. Instead, their walls are covered with granulation tissue. This granulation tissue is a type of new tissue that forms on top of a wound when it heals.
Simply put, a pancreatic pseudocyst is not really a separate structure, but rather a lesion caused by inflammation. A pancreatic cyst is a growth in the wall of the pancreas that develops from its own tissue. It can contain both liquid and solid material. Some cysts can turn into cancer. However, pseudocysts are not a precancerous condition.
Is this pancreatic pseudocyst dangerous?
Most of the time, pancreatic pseudocysts do not turn into cancer, and they rarely cause serious complications. Most of them get better on their own over time. However, if these cysts grow large, there is a small risk of affecting nearby organs or blood vessels. Sometimes they can also become infected. That's when doctors intervene and treat them. So there's no need to panic, but it's important to be aware of this.
How common is this condition?
Pseudocysts of the pancreas are a condition that can occur in about 35% of people with chronic pancreatitis and about 10% of people with acute pancreatitis. Pseudocysts are the most common type of cyst in the pancreas. They account for about 75% of all pancreatic cysts. However, in general, they are not very common. They affect about 3% of adults per year. They are very rare in children.
What causes pancreatic pseudocysts?
The main cause of this is inflammation of the pancreas, which is `(Pancreatitis)`. The main cause of `(Pancreatitis)` that causes pseudocysts to form is alcohol use . 70% of pancreatic pseudocysts are caused by alcohol-related pancreatitis. The second main cause is pancreatitis caused by gallstones. In children, this condition is often caused by some kind of injury `(Trauma).`
Imagine, when the pancreas becomes inflamed due to pancreatitis, or when it is injured in an accident, the pancreatic duct can become blocked, or its connection to the intestine can be broken. Then, some of the fluid produced by the pancreas leaks into the space inside the abdomen, that is, the abdominal cavity. This fluid collects between the walls of the organs, and a protective sac forms around it, as I mentioned earlier. That is what is called a pseudocyst.
What are the symptoms of a pancreatic pseudocyst?
Small pseudocysts may not cause any symptoms. However, larger ones may. Their symptoms can be similar to those of pancreatitis. However, they usually develop several weeks after acute pancreatitis, or after chronic pancreatitis has progressed and affected the pancreatic duct.
Common symptoms:
- Stomach pain: This is the main symptom.
- Bloating: Your stomach may feel full.
- Anorexia: The feeling of not wanting to eat.
- Nausea or vomiting: These symptoms are also common.
Symptoms if complications occur:
Sometimes, if complications occur, symptoms such as these may also occur:
- Fever or chills: This could be a sign of an infection.
- Increased heart rate:
- Dizziness or feeling light-headed:
- Jaundice: Yellowing of the eyes and skin.
What are the possible complications of a pancreatic pseudocyst?
Although complications are rare, it's good to be aware of them.
- Infection: While most pseudocysts contain only pancreatic fluid, some may contain pieces of dead tissue. When this happens, germs such as bacteria can eat away at the dead tissue and cause an infection. An infected pseudocyst can be very dangerous if it bursts. Although this is rare, if it does, the infection can spread to the inside of the abdomen, leading to a condition called septicemia.
- Vessel compression: A large pseudocyst can compress a nearby blood vessel or bile duct, which can block blood flow or bile flow through the duct. The pseudocyst can also compress the pancreatic duct, causing further complications.
- Gastrointestinal obstruction: A large pseudocyst can block the stomach or small intestine, making it difficult to eat or drink. This can lead to difficulty eating and defecating.
- Hemorrhage: If a pseudocyst is pressed against a blood vessel, the wall of that vessel can be damaged and cause bleeding. If blood leaks from the blood vessel into the pseudocyst, the cyst can burst.
Remember, not everyone develops these complications. Most of the time, pseudocysts heal without any problems.
How do doctors diagnose pancreatic pseudocysts?
Doctors can usually identify pancreatic pseudocysts with a good quality scan, such as a contrast CT scan or MRI scan. But sometimes, they need to take a sample to determine whether it is a pseudocyst or another type of tumor. They use endoscopic ultrasound and fine needle aspiration to do this.
Endoscopic ultrasound
This involves a combination of an endoscopy and an ultrasound. The doctor inserts a long tube (endoscope) with a small camera attached down your throat and into your small intestine. Then, another thin tube with a small part of the ultrasound machine is passed through the larger tube to examine the pancreas.
Fine needle aspirationFine needle aspiration
This is a type of biopsy. During the endoscopy, the doctor can insert a thin, hollow needle through the tube and take a sample of fluid and tissue from the pseudocyst. These samples are then sent to a laboratory for testing.
How do these pseudocysts appear on scans?
Our pancreas is roughly shaped like a fish - with a head, a middle part and a tail. About two-thirds of pseudocysts develop in the tail part of the pancreas, and the other third in the head part. They are usually round in shape, with a smooth surface and clear walls. Inside is a clear, watery fluid. They can vary in size from 2 to 30 centimeters. Some people have one, while others have several.
How do doctors treat pancreatic pseudocysts?
Most pancreatic pseudocysts resolve on their own over time. Doctors monitor them and provide supportive care as needed. For example:
- Painkillers: Medicine is given to reduce pain.
- IV fluids: Things like saline are given to prevent dehydration and provide the body with fluids it needs.
- Nutrition (through a tube or intravenously (IV): If you are unable to eat, nutrition is given through a tube or intravenously.
If pseudocysts do not heal on their own, or if they show signs of complications, doctors will intervene and treat them.
How long does it take for a pancreatic pseudocyst to heal?
Doctors usually intervene if pseudocysts have been present for more than six weeks. About a third of them will heal on their own within this time. If you have multiple pseudocysts, or if you have long-term complications, such as scarring from chronic pancreatitis, they may be less likely to heal on their own.
What are the treatments for a complicated, high-risk pseudocyst?
Doctors treat pseudocysts by draining them. This can be done in several ways. Endoscopic drainage is usually the first choice. However, in some cases, other methods, such as surgery, may be necessary. Endoscopic drainage is a less invasive method and has similar long-term results to surgery.
Cystogastrostomy
This is the standard procedure. A cystogastrostomy is a procedure that creates a connection between the pseudocyst and your stomach, allowing the fluid in the cyst to drain into your stomach. Depending on where the pseudocyst is located, this connection may be made to the small intestine or the pancreatic duct.
Your stomach and small intestine can handle the fluid that comes out of the pseudocyst very well, because both have a special lining that protects them from digestive enzymes and acids. (Pancreatic fluid normally goes into the small intestine.) Once all the fluid is gone, the cyst wall will dissolve on its own.
What can you expect after treatment for a pancreatic pseudocyst?
Treatment for a pancreatic pseudocyst will require a few days in the hospital. After that, you will be asked to come back in a few weeks to have the stents or drainage tubes removed. Treatments to remove the fluid are more than 90% successful. However, in rare cases, pseudocysts can recur.
When should you see a doctor about a pancreatic pseudocyst?
If you have symptoms of pancreatitis, see a doctor immediately. This means: pain in your stomach that radiates to your back, and you have nausea and/or vomiting. If you have recently been treated for pancreatitis and your symptoms return after four to six weeks, you may have a pancreatic pseudocyst.
Pancreatic pseudocysts are a common side effect of pancreatitis. They can prolong your treatment and cause you to need more treatment just when you think you've finished. While this can be a real concern, remember that most pseudocysts don't cause new problems or require new treatment.
Doctors are concerned about pseudocysts, but they often just monitor them. If you have symptoms, they treat them. If pseudocysts require surgery, draining the fluid usually resolves the problem. These treatments are often minimally invasive, meaning they have less impact on the body.
Take-Home Message
Okay, so here are some things you need to remember from what we've talked about:
- A pancreatic pseudocyst is a sac-like fluid-filled sac that forms when the pancreas is damaged, especially due to pancreatitis.
- This is not a real tumor, so don't be too afraid that it will turn into cancer.
- Most of the time, these will get better on their own. However, if they become large, infected, or have other complications, they may require treatment.
- The main cause is alcohol-induced pancreatitis.
- Symptoms may include stomach pain, bloating, loss of appetite, and nausea.
- Doctors diagnose these through tests such as `(CT scan)`, `(MRI)`, and `(Endoscopic ultrasound)`.
- The main treatment is drainage, which can often be done endoscopically.
- If you develop symptoms of pancreatitis, or if symptoms return after a short period of treatment, be sure to see a doctor.
The most important thing is not to panic and follow the correct medical advice. Wishing you a speedy recovery!
👩🏽⚕️ Additional questions (FAQs)
💬 Is Pancreatic Pseudocyst a dangerous cancer that develops in the pancreas?
No! 'Pseudo' here means false, and 'Cyst' means a tumor. That means this is not actually cancer or a true cyst. This name is given to a fluid-filled cyst that forms when the pancreas is severely injured (Pancreatitis), causing it to leak enzymes, blood, and dead tissue to collect in a 'pool/like' manner.
💬 What are the symptoms we feel when this pseudocyst grows inside the stomach?
If the tumor is small, there is no pain. But when it is large (more than 6 cm), it presses on the rest of the intestines/stomach, so you will have unbearable pain in the upper abdomen (from the chest down to the back). You may also feel full even after eating a little, vomit, and have a small lump in the stomach.
💬 Will this cyst burst? What surgery is done for this?
Although it is less likely to burst, it is more likely to become an infected abscess! Doctors will wait and watch if it is not large and will go away on its own in a few months. However, if it is large and painful, it is treated with a very safe small surgery in which an endoscopy camera is inserted through the stomach, the abscess is punctured/drained, and all the fluid in it is drained into the stomach.
` Pancreas, pseudocyst, pancreatitis, stomach pain, digestive system, endoscopy, medical treatment
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