Pancreatic pseudocysts are collections of pancreatic secretions surrounded by a nonepithelial-lined fibrous wall of granulation tissue. They may develop:

• After an episode of acute pancreatitis
• In the course of chronic pancreatitis
• After pancreatic trauma

Pseudocysts may be asymptomatic and resolve spontaneously (20-25%). In the remaining cases thay become symptomatic and enlarge. When present, symptoms include pain, fever, weight loss, compression on surrounding organs (bowel obstruction, jaundice), and palpable mass on abdominal examination. 

Enlarging pseudocysts, or symptomatic pseudocysts inherit an increased risk (10-50%) of rupture, intracystic or abdominal hemorrhage (due to the erosion of nearby vessels), internal fistulas (with the stomach or colon) and infection. Massive hemorrhage requires emergency angiography and therapeutic embolization, or emergency laparotomy.

Elective therapy includes non-surgical and surgical options.

• Non-surgical options: percutaneous drainage (external drainage placed under CT or ultrasound guidance), endoscopic drainage (internal plastic stent placed endoscopically). Internal drainage assumes adherence between the pseudocyst and the adjacent segment of intestine (usually the stomach)
• Surgical options: these consist of internal surgical derivations (cystogastrostomy and Roux-en-Y cystojejunostomy, to learn more click here).