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    Pancreatic Pseudocyst

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    amarch517
    This document discusses pancreatic pseudocysts and their treatment. It defines pancreatic pseudocysts as encapsulated fluid collections that form outside the pancreas at least 4 weeks after acute pancreatitis, with a well-defined mature wall. Walled-off necrosis is described as a heterogeneous collection that forms after over 4 weeks of necrotizing pancreatitis within areas of devitalized pancreas. Common treatments for pancreatic pseudocysts include cystogastrostomy, cystoduodenostomy, and roux-en-y cystojejunostomy. Distal pancreatectomy with splenectomy may be used in cases with splenic involvement. Treatments for walled-off necrosis include percutaneous

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    Download as PPTX, PDF, TXT or read online from Scribd

    Pancreatic Pseudocyst

    Uploaded by

    amarch517
    161 views20 pages
    This document discusses pancreatic pseudocysts and their treatment. It defines pancreatic pseudocysts as encapsulated fluid collections that form outside the pancreas at least 4 weeks after acute pancreatitis, with a well-defined mature wall. Walled-off necrosis is described as a heterogeneous collection that forms after over 4 weeks of necrotizing pancreatitis within areas of devitalized pancreas. Common treatments for pancreatic pseudocysts include cystogastrostomy, cystoduodenostomy, and roux-en-y cystojejunostomy. Distal pancreatectomy with splenectomy may be used in cases with splenic involvement. Treatments for walled-off necrosis include percutaneous

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    Pancreatic Pseudocyst

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    This document discusses pancreatic pseudocysts and their treatment. It defines pancreatic pseudocysts as encapsulated fluid collections that form outside the pancreas at least 4 weeks after acute pancreatitis, with a well-defined mature wall. Walled-off necrosis is described as a heterogeneous collection that forms after over 4 weeks of necrotizing pancreatitis within areas of devitalized pancreas. Common treatments for pancreatic pseudocysts include cystogastrostomy, cystoduodenostomy, and roux-en-y cystojejunostomy. Distal pancreatectomy with splenectomy may be used in cases with splenic involvement. Treatments for walled-off necrosis include percutaneous

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    161 views20 pages

    Pancreatic Pseudocyst

    Uploaded by

    amarch517
    This document discusses pancreatic pseudocysts and their treatment. It defines pancreatic pseudocysts as encapsulated fluid collections that form outside the pancreas at least 4 weeks after acute pancreatitis, with a well-defined mature wall. Walled-off necrosis is described as a heterogeneous collection that forms after over 4 weeks of necrotizing pancreatitis within areas of devitalized pancreas. Common treatments for pancreatic pseudocysts include cystogastrostomy, cystoduodenostomy, and roux-en-y cystojejunostomy. Distal pancreatectomy with splenectomy may be used in cases with splenic involvement. Treatments for walled-off necrosis include percutaneous

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    Pancreatic

    Pseudocyst

    Presenter: Dr. Abishek Thapa


    Resident
    Department of Surgery
    KMCTH
    Pancreatic pseudocyst
    CECT criteria
    Well circumscribed, usually round or oval
    Homogeneous fluid density
    No non-liquid component
    Well defined wall; that is, completely encapsulated
    Maturation usually requires >4 weeks after onset of
    acute pancreatitis; occurs after interstitial oedematous
    pancreatitis

    Banks P et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and
    definitions by international consensus. Gut [Internet]. 2013 Jan [cited 2014 Jul 10];62(1):10211.
    Pancreatic pseudocyst
    1) Six or Six Rule
    >6cm size, >6weeks duration
    Unlikely to resolve
    High change of infection.

    2) Infected PPC

    3) Symptomatic PPC

    (O'Malley VP, Cannon JP, Postier RG. Pancreatic pseudocysts: cause, therapy, and results. Am J
    Surg. 1985;150:680682)
    INTERVENTION MODALITIES
    SURGICAL
    ENDOSCOPIC
    Transgastric - Cystogastrostomy
    endoscopic drainage Cystoduodenostomy
    Transduodenal Roux-en-Y
    endoscopic drainage cystojejunostomy
    Transpapillary Distal pancreatectomy
    pancreatic duct splenectomy
    stenting
    Laparoscopic Open
    Case Series
    Clinical Profile
    Age Pre Op Diagnosis Surgery

    Lap assisted (5
    Pancreatic
    ports)
    pseudocyst
    Case 1 41/M Cystogastrostomy
    secondary to acute
    with lap
    pancreatitis
    cholecystectomy

    Lap. Assisted
    Recurrent cystogastrostomy
    Pancreatitis with with right
    Case 2 21 Y/F
    pancreatic subhepatic drain
    pseudocyst with laproscopic
    cholecystectomy.
    Laparoscopic cystogastrostomy
    Video
    Clinical profile
    Reason for
    Age Pre Op Diagnosis Surgery the choice of
    surgery

    Exploratory laparotomy, Walled off


    Pancreatic pseudocyst
    43 adhesiolysis, necrosectomy necrosis,
    Case 3 with splenic and left
    Y/M cholecystectomy,, splenic vein
    gastric vein thrombosis
    splenectomy thrombosis

    Walled off
    Lap converted to open necrosis-
    Case 4 48Y/F Pseudopancreatic cyst
    cystogastrostomy solid
    component
    Necrosectomy >6 weeks, no
    wall
    Pancreatic pseudocyst Re- necrosectomy after 2 formation,
    Case 5 23Y/F
    with pancreatitis weeks, FJ sick patient,
    Organized
    Re-exploration (Hemorrhage) necrosis
    Clinical profile

    Reason for
    Case Age Pre Op Diagnosis Surgery choice of

    Clinical profile Surgery

    Exploratory laparotomy Pseudocyst in


    Pancreatic Pseudocyst
    with distal the tail of
    49Y/ with Pancreatic duct
    Case 6 pancreatectomy with pancreas
    M calculi with Chronic
    splenectomy with Freys Chronic
    pancreatitis
    procedure pancreatitis
    Distal end of
    pancreas with the
    pseudocyst
    Specimen: distal of
    pancreas with
    pseudocyst and
    spleen
    Pancreatic duct
    identified under
    USG guidance
    Laying open of the pancreatic duct, head coring and lateral pancreatojejunostomy
    Review of literature
    Definition
    Pancreatic Pseudocyst Walled Off Necrosis Organised necrosis
    Definition - >4 weeks of >6weeks duration,
    - >4 weeks. necrotising But no mature wall
    - Encapsulated pancreatitis formed
    collection of fluid - Encapsulated
    - well defined / mature heterogeneous
    wall collection
    - usually outside the - well defined / mature
    pancreas wall

    Banks PA et al. Classification of acute pancreatitis--2012: revision of the


    Atlanta classification and definitions by international consensus. Gut [Internet].
    2013 Jan [cited 2014 Jul 10];62(1):10211.
    Pancreatic Walled Off
    Pseudocyst Necrosis

    Banks PA et al. Classification of acute pancreatitis--2012: revision of the Atlanta


    classification and definitions by international consensus. Gut [Internet]. 2013 Jan
    [cited 2014 Jul 10];62(1):10211.
    Pancreatic Pseudocyst Treatment
    Cystogastrostomy
    (Sharma D, Kataria S, Pathak R, Barua B, Lal R. Laparoscopic drainage of a large pancreatic
    pseudocyst. JSLS [Internet]. [cited 2014 Sep 9];16(4):6757)

    Cystoduodenostomy
    (Vavrecka A, Kuzela L, Novotna T, Hrcka R, Oltman M. [Endoscopic therapy of pancreatic pseudocysts].
    cited 2014 Sep 12];101(2):936 )

    Roux-en-Y cystojejunostomy
    (Sun Y, Cai H, Bai J, Zhao H, Fu Z, Miao Y. Totally laparoscopic Roux-en-Y cystojejunostomy as a sole
    treatment option for pancreatic pseudocysts: a report of four cases. Chin Med J (Engl) [Internet]. 2010
    Aug 5 [cited 2014 Sep 12];123(15):21424.)

    Distal pancreatectomy splenectomy


    (Accetta P, Accetta I, Accetta R, Campos KB, Rodrigues MFO. Pancreatic pseudocyst with splenic
    involvement. Case report. Rev Col Bras Cir [Internet]. 2010 Dec [cited 2014 Aug 27];37(6):4579. )
    Walled Off Necrosis Treatment
    Percutaneous drainage

    Cystogastrostomy + Necrosectomy
    (Sasnur P, Nidoni R, Baloorkar R, Sindgikar V, Shankar B. Extended Open Transgastric Necrosectomy (EOTN) as a
    Safer Procedure for Necrotizing Pancreatitis. J Clin Diagn Res [Internet]. 2014 Jul)

    Direct Endoscopic Necrosectomy

    Step up Approach
    (Kumar N, Conwell DL, Thompson CC. Direct Endoscopic Necrosectomy Versus Step-Up Approach for Walled-Off
    Pancreatic Necrosis: Comparison of Clinical Outcome and Health Care Utilization. Pancreas [Internet]. 2014 Aug 11)

    Temporary cystogastrostomy with self-expanding


    metallic stent
    (Belle S, Collet P, Post S, Kaehler G. Temporary cystogastrostomy with self-expanding metallic stents for pancreatic
    necrosis. Endoscopy [Internet]. 2010 Jun )
    Conclusion

    CECT cannot always differentiate between PPC


    and WON

    Other modalities such as MRI and EUS with FNA


    are advised

    Treatment of PPC, WON are different


    THANK YOU

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