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Condition: Pancreatic Cysts (pseudocyst, fluid collections, duplication cyst)
Overview (“What is it?”)
- The pancreas is a gland located in the abdomen surrounded by the stomach, small intestine, liver, spleen and gallbladder (see Figure 1). The pancreas is a gland that aids in two bodily functions—digestion and blood sugar regulation.
- Pancreatic cysts are collections of fluid that can be due to congenital (someone is born with it) or acquired (something that developed after birth) conditions. Pancreatic cysts are classified based on the underlying cause of the fluid collection.
- Pancreatic cysts are often classified into congenital and developmental, retention, enteric duplication and pseudocysts. The first three types of cysts are rare.
- Congenital and developmental cysts may be detected on prenatal ultrasound. These cysts may be associated with cysts in other areas of the body.
- Retention cysts are a result of blockage of a portion of the gland downstream causing a back-up of fluid.
- Duplications of the gastrointestinal (enteric) system may involve the pancreas and lead to cyst formation. Duplication cysts are abnormal portions of the intestine. In this location, there may be duplication of the pancreas or duplication of an organ next to the pancreas.
- The most common cause of a pancreatic fluid collection is a pseudocyst. This type of fluid collection is a result of inflammation of the pancreas (pancreatitis) or trauma to the pancreas. The fluid leaks from the injured pancreatic ducts and collects in areas next to the pancreas. Over time, a capsule forms around this fluid collection becoming a pseudocyst.
Signs and Symptoms (“What symptoms will my child have?”)
- Congenital/developmental cysts or enteric duplications may be seen on prenatal ultrasound. Early signs of cysts may be feeling of fullness or bloating and early satiety or decreased appetite. A history of pancreatitis or pancreatic trauma may be an early indication that a pseudocyst may form.
- Later signs/symptoms include pain and discomfort due to the cyst. A mass may be detected on physical exam if the cyst becomes large. Patients may also develop jaundice, persistent vomiting, weight loss and fluid within the abdomen.
Diagnosis (“What tests are done to find out what my child has?”)
- Labs and tests: The most common lab tests include a serum amylase and lipase as well as liver function tests (bilirubin, alkaline phosphatase, GGT, AST, ALT). In many cases, all or most of these labs will be normal.
- Diagnosis is usually first made with ultrasound.
- Once the diagnosis is made with ultrasound, additional imaging with CT scan or MRI maybe obtained to provide more detailed anatomic information about the cyst.
- Conditions that mimic this condition include other cystic lesions in nearby organs (adrenal gland, duodenum, stomach, etc.).
Treatment (“What will be done to make my child better?”)
- There are really no medications that can be used to treat pancreatic cysts. Some pancreatic fluid collections that develop after trauma or pancreatitis may resolve over time. Medications may be required to treat complications associated with pancreatic cysts (i.e. antibiotics if the cyst becomes infected).
- Surgery is the main treatment for pancreatic cysts.
- Preoperative preparation: Patients will usually have preoperative labs and imaging (see above). Patients will often require blood to be available during surgery. Children will not be able to eat the morning of surgery.
- Postoperative care: Most patients will not be allowed to eat or drink immediately after surgery. This will allow for everything to heal on the inside. Many patients will have a tube in place to keep the stomach empty. This tube is usually inserted through the nose and into the stomach while the patient is asleep under anesthesia. Some patients may have a drain in place after surgery. Most of the time, the drain is removed prior to going home. However, in some instances the drain may be left in place to collect additional fluid. If this is the case, parents will be given careful instruction on how to care for the drain. In most instances, when children are discharged from the hospital, they are eating normally and require minimal additional care.
- Risks/Benefits: The standard risks of surgery include bleeding, blood transfusion, infection, anesthetic risks, damage to surrounding structures, leakage from the pancreas and recurrent fluid collections. The benefit of surgery is to relieve symptoms and to prevent future complications associated with the pancreatic cysts (infection, bleeding, etc.).
Home Care (“What do I need to do once my child goes home?”)
- Diet: In most cases, a regular diet
- Activity: No heavy activity for 4-6 weeks for an open operation and 2-4 weeks for a laparoscopic operation
- Wound care: None, unless a drain is still in place
- Medicines: Pain medicine for a couple of days
- What to call the doctor for: Fever greater than 101⁰ F or 38⁰C, persistent vomiting, wound problems (redness or drainage), or worsening pain.
- Follow-up care: With your surgeon 1-2 weeks after discharge.
Long-Term Outcomes (“Are there future conditions to worry about?”)
In most cases, surgical excision or drainage of the cyst will be curative.
Author: Steven L. Lee, MD
Editors: Patricia Lange, MD; Marjorie J. Arca, MD