Abstract

Diagnosis and management of pseudocysts of the pancreas often present difficult clinical problems. We reviewed our 18 patients with pancreatic pseudocysts treated between January 1985 and October 1989 to identify criteria for operative and nonoperative management based on size of the lesion on computerized tomography. Diagnostic modalities, etiology, management, and concurrent medical problems were also evaluated. Alcohol (72%) was the most common etiologic agent. Hypertension (39%), peptic ulcer disease (28%), and chronic obstructive pulmonary disease (22%) were the most common associated medical problems. CT scan was the most frequently used (100%) and most accurate (100%) preoperative diagnostic tool. Preoperative ERCP modified the treatment plan in only one patient. All pseudocysts smaller than 3 cm on CT scan were managed nonoperatively, without recurrence (mean follow-up of 3 months). The most commonly performed surgical procedure was cystogastrostomy. External drainage procedures had a higher complication rate (100% vs 14%) and higher recurrence rate (33% vs 0%) than internal drainage procedures. Attempted percutaneous drainage in one patient resulted in recurrence. Pancreatic pseudocysts less than 3 cm in diameter can be safely managed nonoperatively. CT scan remains the diagnostic tool of choice. Preoperative ERCP evaluation is of limited utility and needs further evaluation. Internal drainage procedures provide the best surgical results.