What are pancreatic cysts?
Pseudocysts do not have their own lining: their wall is made up of compacted neighboring tissues. They appear as a result of acute or exacerbation of chronic pancreatitis and often resolve on their own within a few months. True cystic formations are lined with epithelium and belong to tumors: serous ones are almost always benign, and mucinous and intraductal papillary ones can degenerate. Separately, congenital cysts and rare parasitic cysts are distinguished. It is membership in one group or another that determines whether to observe the formation or remove it.
- Pseudocyst is the most common option after pancreatitis or trauma
- Serous cystadenoma - minimal risk of malignancy
- Mucinous cystadenoma - requires more active tactics
- Intraductal papillary mucinous tumor
- Congenital and parasitic cysts - rare
Causes and risk factors
The main cause of pseudocysts is inflammation of the gland, in which the ducts are damaged and pancreatic juice leaks into the surrounding tissue. The body delimits this accumulation, and a cavity is formed. Contributors to this include alcohol abuse, gallstones, high triglyceride levels, blunt abdominal trauma, and surgery on the upper abdominal organs. Tumor cysts develop independently, more often in people over 50 years of age, and are not directly related to inflammation.
- Previous acute or chronic pancreatitis
- Regular alcohol intake
- Gallstone disease
- Abdominal injury or surgery
- High triglyceride levels
- Age over 50 years for tumor forms
Symptoms
Small cysts usually do not manifest themselves in any way and become a finding during an ultrasound done for another reason. When the cavity enlarges, a dull or girdling pain appears in the upper abdomen, radiating to the back, a feeling of heaviness after eating and rapid satiety. A large cyst in the area of the head of the gland can compress the bile duct and cause jaundice, and compression of the duodenum leads to vomiting of eaten food. A sharp deterioration in condition indicates a complication.
- Dull pain in the epigastric region and left hypochondrium
- Referral of pain to the back, relief when sitting and bending forward
- Nausea, vomiting, early satiety
- Bloating, loose stools
- Palpable formation in the abdomen with large sizes
- Weight loss
Diagnostics
The examination begins with an ultrasound of the abdominal organs: it shows the cavity itself and its size. This is not enough to decide on treatment, so MSCT or MRI with contrast is prescribed - they allow you to see the structure of the wall, septum, connection with the duct and parietal growths. The most accurate method is endoscopic ultrasound with fine-needle puncture: the contents of the cyst are examined for enzymes, tumor markers and cells. Amylase, lipase, inflammation indicators and liver function tests are assessed in the blood.
- Ultrasound of the abdominal organs
- MSCT with intravenous contrast
- Abdominal MRI and cholangiopancreatography
- Endoscopic ultrasound with puncture of contents
- Alpha amylase and blood lipase
- Complete blood count and liver tests
Treatment and observation
Small asymptomatic pseudocysts are simply observed in the first months: some of them resolve. If the cavity is more than a few centimeters, persists for longer than six months, causes pain or puts pressure on neighboring organs, it is emptied. A modern option is endoscopic drainage through the wall of the stomach or duodenum under EUS control. For tumor cysts with signs of risk, resection of the corresponding part of the gland is performed. The volume of intervention and the timing of control studies are determined by the doctor; self-medication is unacceptable here.
- Observation with re-examination after 3–6 months
- Refusal of alcohol, small meals with limited fat
- Pain relief and enzyme preparations as prescribed by a doctor
- Endoscopic drainage into the stomach or intestine
- Percutaneous drainage under ultrasound guidance
- Resection of part of the gland for a tumor cyst
