Learn About Pancreatic Pseudocyst
A pancreatic pseudocyst is a fluid-filled sac in the abdomen that arises from the pancreas. It may also contain tissue from the pancreas, enzymes, and blood.
Pancreatitis - pseudocyst
The pancreas is an organ located behind the stomach. It produces chemicals (called enzymes) needed to digest food. It also produces the hormones insulin and glucagon.
Pancreatic pseudocysts most often develop after an episode of severe pancreatitis. Pancreatitis happens when your pancreas gets inflamed. There are many causes of this problem.
This problem may sometimes occur:
- In someone with long-term (chronic) swelling of the pancreas (pancreatitis), most often due to alcohol abuse
- After trauma to the belly, more often in children
The pseudocyst happens when the ducts (tubes) in the pancreas are damaged and fluid with enzymes cannot drain.
Symptoms can occur within days to months after an attack of pancreatitis. They include:
- Bloating of the abdomen
- Constant pain or deep ache in the abdomen, which may also be felt in the back
- Nausea and vomiting
- Loss of appetite
- Difficulty eating and digesting food
Treatment depends on the size of the pseudocyst and whether it is causing symptoms. Many pseudocysts go away on their own. Those that remain for more than 6 weeks and are larger than 5 centimeters (about 2 inches) in diameter may need treatment. However, size and duration do not always mean treatment is needed, especially in a person without any symptoms and whose pseudocyst is not getting bigger.
Possible treatments include:
- Drainage through the skin using a needle, most often guided by a CT scan.
- Endoscopic-assisted drainage using an endoscope. In this, a tube containing a camera and a light is passed down into the stomach).
- Surgical drainage of the pseudocyst. A connection is made between the cyst and the stomach or small intestine. This may be done using a laparoscope.
The Johns Hopkins Hospital
Gastroenterologist Mouen Khashab specializes in therapeutic endoscopy, and he oversees this group of practitioners across the Johns Hopkins enterprise. Nationally and internationally known in the field of interventional endoscopy, Dr. Khashab has contributed immensely to the field’s advancement as a minimally invasive means to treat gastrointestinal and pancreaticobiliary disorders. Dr. Khashab earned his medical degree from the American University of Beirut Faculty of Medicine, and subsequently completed a residency in internal medicine and a fellowship in gastroenterology at Indiana University. He then completed a two-year fellowship at The Johns Hopkins Hospital before joining the faculty in 2011. A busy researcher, Dr. Khashab has published more than 600 papers in peer-reviewed journals. In 2013, he described the procedure called gastric peroral endoscopic myotomy (known as G-POEM) and was able to disseminate and teach it all over the world. Other procedures that he expanded include peroral endoscopic myotomy (POEM), peroral endoscopic myotomy with fundoplication (POEM-F), Zenker’s peroral endoscopic myotomy (Z-POEM) and full thickness resection. In 2022, he received the Master Endoscopist Award from the American Society for Gastrointestinal Endoscopy (ASGE) for his numerous contributions to the field. His procedural expertise includes endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), interventional EUS, submucosal endoscopy, POEM/achalasia, endoscopic mucosal resection, endoscopic submucosal dissection, luminal stenting, large polyp resection and Barrett’s therapy, among others. Dr. Khashab is involved with multiple gastrointestinal societies and has served on many committees, including the ASGE Standards of Practice Committee, which is in charge of formulating guidelines for the practice of endoscopy. He has also served as an associate editor for the journal Endoscopy, a premier journal in the field. Khashab is a highly sought-after speaker at national and international conferences, and he has participated in multiple live endoscopy conferences. Outside of academic medicine, Dr. Khashab is an entrepreneur. His major interest is in new technology and medical devices, and his goal is to disrupt the field by introducing technology that makes endoscopic procedures safer, easier, efficient and more scalable. Dr. Khashab is rated as an Elite provider by MediFind in the treatment of Pancreatic Pseudocyst. His top areas of expertise are Achalasia, Pancreatic Pseudocyst, Bile Duct Obstruction, Endoscopy, and Gastric Bypass.
Johns Hopkins Health Care & Surgery Center - Green Spring Station, Lutherville
Vikesh Singh is a gastroenterologist who specializes in pancreatology and pancreaticobiliary endoscopy. He evaluates and treats patients with inflammatory diseases of the pancreas, including acute and chronic pancreatitis and autoimmune pancreatitis as well as the complications of these diseases. After earning his medical degree from the Johns Hopkins University School of Medicine, Dr. Singh remained at Johns Hopkins to complete residency training in internal medicine. He pursued fellowship training in gastroenterology at Brigham and Women’s Hospital, and earned a master’s degree in epidemiology from the Harvard T. H. Chan School of Public Health. He then returned to Johns Hopkins, where he completed a two-year advanced endoscopy fellowship with a focus on pancreaticobiliary endoscopy. Dr. Singh has been on the faculty at Johns Hopkins since 2008, and rose to the rank of professor in 2021. His research interests include acute and chronic pancreatitis, autoimmune pancreatitis, exocrine pancreatic insufficiency, and novel methods to evaluate and treat abdominal pain. Dr. Singh is a member of the board of directors of the National Pancreas Foundation, chair of the Pancreatic Disorders Section of the American Gastroenterological Association, a councilor for the International Association of Pancreatology and a member of the inaugural medical advisory board for the Familial Chylomicronemia Syndrome Foundation. Dr. Singh is rated as an Elite provider by MediFind in the treatment of Pancreatic Pseudocyst. His top areas of expertise are Exocrine Pancreatic Insufficiency, Hereditary Pancreatitis, Acute Pancreatitis, Pancreatectomy, and Endoscopy.
Thomas Kowalski is a Hepatologist and a Gastroenterologist in Philadelphia, Pennsylvania. Dr. Kowalski is rated as an Elite provider by MediFind in the treatment of Pancreatic Pseudocyst. His top areas of expertise are Hereditary Pancreatitis, Jaundice, Pancreatic Pseudocyst, Endoscopy, and Gastric Bypass. Dr. Kowalski is currently accepting new patients.
The outcome is generally good with treatment. It is important to make sure that it is not a pancreatic cancer that starts in a cyst, which has a worse outcome.
Complications may include:
- A pancreatic abscess can develop if the pseudocyst becomes infected.
- The pseudocyst can break open (rupture). This can be a serious complication because shock and excess bleeding (hemorrhage) may develop.
- The pseudocyst may press down on (compress) nearby organs.
If you are known to have a pseudocyst, rupture of the pseudocyst is a medical emergency. Go to the emergency room or call 911 or the local emergency number if you develop symptoms of bleeding or shock, such as:
- Fainting
- Fever and chills
- Rapid heartbeat
- Severe abdominal pain
The way to prevent pancreatic pseudocysts is by preventing pancreatitis. If pancreatitis is caused by gallstones, the provider will perform surgery to remove the gallbladder (cholecystectomy).
When pancreatitis occurs due to alcohol abuse, you must stop drinking alcohol to prevent future attacks.
When pancreatitis occurs due to high blood triglycerides, this condition should be treated.
Summary: Acute pancreatitis is one of the most common gastrointestinal disorders requiring hospitalization worldwide. Pancreatic fluid collections can occur as a consequence of acute and chronic pancreatitis and can result in significant morbidity and mortality, including significant abdominal pain, gastric outlet obstruction, biliary obstruction, organ failure, persistent unwellness, infection and sepsis....
Summary: The goal of this prospective, single-center observational study is to evaluate the safety and effectiveness of the HANAROSTEN® HOT Plumber™ with Z-EUSIT™ for draining pancreatic pseudocysts. The main questions the study aims to answer are: * Does the device reduce the size of pancreatic pseudocysts by at least 50% and improve associated symptoms within 30 to 60 days? * Can the stent be successfull...
Published Date: December 31, 2023
Published By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Javed AA, Lafaro KJ. Pancreas: Management of pancreatic pseudocyst. In: Cameron J, ed. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:539-650.
Van Buren G, Fisher WE. Acute and chronic pancreatitis. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2024. Philadelphia, PA: Elsevier; 2024:175-182.
Vege SS. Acute pancreatitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 58.