Algorithm for the diagnosis and treatment of pancreatic pseudocysts

Abstract

Algorithm for the Diagnosis and Treatment of Pancreatic Pseudocysts - Review, Clinical Study The Pancreatic Pseudocysts (PP) are single or multiple fluid collections, composed of pancreatic juice, blood, necrotic tissue, localized inside or outside the pancreas, without their own walls, instead having a “pseudo-wall” without epithelium, following a process of encysting fibrosclerosis, persistent over 4 weeks, without clinical signs of infection. PP is a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. The aim of this clinical study was to optimize the diagnosis methods and to establish a rational surgical management of the PP treatment, through the correlation of surgical techniques with the optimal surgical moment, given by the maturation degree of pseudocystic wall. This study included the results of the complex treatment of 191 patients with PP, communicating or not with pancreatic duct, operated in the Hepatobiliary-Pancreatic Surgery Section at the Republican Clinical Hospital from Chisinau, in period of 1994-2009. The mean age of the patients was 45 years old. The study proposes a modem diagnosis algorithm, which includes clinical, laboratory dates and imagistic explorations (echography, simple abdominal radiography, gastro and duodenography, endoscopic retrograde cholangiography (ERCP), computer tomography, magnetic resonance imaging (MRI), wirsungography and intraoperative echography). The surgical indication was done by mature pancreatic pseudocyst, by pancreatic pseudocyst during maturation (less than 6 months from debut) and by pancreatic pseudocyst with postoperative complications, facts which bring to the elaboration of a self surgical management. Different strategies were used for the treatment of PP: endoscopic transpapillary or transmural drainage, percutaneous catheter drainage, or open surgery. The PP represents a disease that affects persons who are in the period of the highest socio-professional productivity and efficiency; their mean age is 45 years old. The diagnosis was accomplished most often by computer tomographic scanning, by ERCP, by ultrasound or by MRI. The successful resolution of pancreatic pseudocysts can be achieved by surgical treatment. The good monitoring of the application of an adequate conservative treatment, possibly occurring under the protection of Octreotide, could allow the development of pseudocystic wall that matures in less than 6 months from debut.