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Pseudocyst – Definition, Causes and Treatment

A pseudocyst is a fluid-filled cavity in body tissue that lacks a true cyst wall. It most commonly occurs as a complication of pancreatic inflammation.

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Things worth knowing about "Pseudocyst"

A pseudocyst is a fluid-filled cavity in body tissue that lacks a true cyst wall. It most commonly occurs as a complication of pancreatic inflammation.

What Is a Pseudocyst?

A pseudocyst is a fluid-filled cavity that forms within body tissue but, unlike a true cyst, does not have a complete epithelial lining. Instead, the wall of a pseudocyst is composed of fibrous, granulation, or inflammatory tissue. Pseudocysts can develop in various organs, but they most frequently occur in the pancreas.

Causes

The most common cause of a pancreatic pseudocyst is acute or chronic pancreatitis (inflammation of the pancreas). Other possible causes include:

Abdominal trauma or injury to the pancreas
Abdominal surgery
Chronic alcohol use as a trigger for pancreatitis
Gallstones blocking the bile duct
Rarely: infections or tumors near the pancreas

Outside the pancreas, pseudocysts may also develop in the spleen, liver, or brain (for example, following a stroke or injury).

Symptoms

Small pseudocysts often cause no symptoms and are discovered incidentally during an ultrasound or CT scan. Larger pseudocysts, however, may cause:

Abdominal pain, particularly in the upper abdomen, which may radiate to the back
Nausea and vomiting
Loss of appetite and weight loss
Bloating and a feeling of fullness
A palpable mass in the abdomen
In advanced cases: jaundice, if the pseudocyst compresses the bile duct

Diagnosis

Pseudocysts are typically diagnosed using imaging techniques:

Ultrasound (sonography): Often the first imaging method used; reveals fluid-filled structures.
Computed tomography (CT): Provides detailed images and allows precise assessment of the size and location of the pseudocyst.
Magnetic resonance imaging (MRI) / MRCP: Particularly useful for visualizing the pancreatic ducts.
Endoscopic ultrasound (EUS): Enables precise evaluation and, if needed, targeted aspiration of fluid for laboratory analysis.

Laboratory tests showing elevated amylase and lipase levels in the blood or within the pseudocyst fluid may also indicate a pancreatic pseudocyst.

Treatment

Not all pseudocysts require treatment. Small, asymptomatic pseudocysts may resolve on their own and are initially monitored. Treatment becomes necessary when:

The pseudocyst is increasing in size
The patient experiences persistent or severe pain
Complications such as infection, bleeding, or rupture occur
Adjacent organs are being compressed or displaced

Endoscopic Drainage

Endoscopic drainage is currently the preferred treatment method. Using an endoscope, a connection is created between the pseudocyst and the stomach or small intestine, allowing the fluid to drain. This minimally invasive procedure has a high success rate.

Percutaneous Drainage

In percutaneous drainage, a needle is inserted through the abdominal wall into the pseudocyst under ultrasound or CT guidance to drain the fluid. This method is frequently used for infected pseudocysts.

Surgical Treatment

When endoscopic or percutaneous methods are not feasible or have been unsuccessful, surgical drainage may be necessary. The pseudocyst is surgically connected to the stomach or intestine to allow drainage.

Complications

Untreated or enlarging pseudocysts can lead to serious complications, including:

Infection and abscess formation
Rupture with leakage of fluid into the abdominal cavity (peritonitis)
Bleeding caused by erosion of adjacent blood vessels
Compression of the bile duct, intestine, or other surrounding structures

References

Banks P. A. et al. - Classification of acute pancreatitis. Gut, 2013;62(1):102-111. Available at: https://gut.bmj.com
Forsmark C. E., Vege S. S., Wilcox C. M. - Acute Pancreatitis. New England Journal of Medicine, 2016;375(20):1972-1981.
Lerch M. M., Mayerle J. - AWMF S3 Guidelines on Pancreatitis, 2021. Available at: https://www.awmf.org

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