PANCREATIC PSEUDOCYST – ACTUAL THERAPEUTIC OPTIONS

BACKGROUND: Pancreatic pseudocyst (PP) is one of the most frequent complications of acute and chronic pancreatitis; patients with these disorders often benefit from interventional treatment, or minimally invasive surgery. Progress of new minimally invasive interventional techniques (endoscopic internal drainage, external drainage guided by ultrasound / CT / laparoscopic surgery) for the treatment of pancreatic pseudocyst formed the basis for the arguments of this article.AIM: The purpose of this article is to analyze and highlight the above views on a series of consecutive cases of pancreatic pseudocyst. MATERIAL AND METHOD: We studied 46 patients diagnosed with pancreatic pseudocyst in a period of 6 years, from 2006 to 2011. RESULTS: 26 patients (56.52%) were treated conservatively and followed periodically by imaging (ultrasound, CT); 20 patients (43.47%) required therapeutic attitude because of symptomatic PP or lack of tendency to resorption (increase in size at successive examinations). 2 patients (4.34%) were drained externally under ultrasound/CT guidance. 10 patients (21.7%) were submitted to endoscopic drainage as follows: 2 transpapillary drainage, 5 transgastric and 3 transduodenal drainage, respectively. Surgical interventions were performed in 8 patients (17.39%), 4 cysto-gastrostomy, 3 cysto-jejunostomy and 3 external drainages (2 patients with dual localization of PP). We noted a postoperative complication after cysto-jejunostomy: upper gastrointestinal bleeding at 6th postoperative day from splenic artery hemorrhage, inside the PP. It was diagnosed by angiography and re-operation was required for hemostasis. Data from the literature concerning the therapeutic protocol in pancreatic pseudocyst ere reviewed. CONCLUSION: The PP management depends on PP site, size and “matureness” and is individualized for each case. Different treatment options are available: external drainage under CT / ultrasound guidance, endoscopic drainage, surgical procedures. To minimize the postoperative morbidity rate, surgical internal drainage is addressed to PP mature over 6 weeks from the last episode of acute pancreatitis.