Describe Pancreatic Pseudocyst in detail.

The Concept

A pancreatic pseudocyst is a collection of pancreatic fluid (rich in amylase) walled off by a wall of granulation and fibrous tissue. It is called a 'pseudo'cyst because it lacks a true epithelial lining — the wall is inflammatory tissue, not epithelium. It typically develops as a complication of acute or chronic pancreatitis (or pancreatic trauma), usually appearing about four or more weeks after the acute episode, the time needed for the wall to mature.

Clinical Features

A pseudocyst may be asymptomatic or present with persistent epigastric pain, a palpable epigastric mass, early satiety or nausea (from pressure on the stomach), and a persistently raised serum amylase. It should be suspected when a patient recovering from pancreatitis fails to settle or develops a mass.

Investigation, Complications & Management

CT or ultrasound confirms and characterises the collection. Many small, asymptomatic pseudocysts resolve spontaneously and can be observed. Drainage is indicated for those that are large, persistent, symptomatic or complicated — the preferred route is often endoscopic (cystogastrostomy), with surgical drainage as an alternative. Complications that force intervention include infection (an abscess), haemorrhage (erosion into a vessel), rupture, and obstruction of adjacent structures.

Distinguishing from Other CYSTS

A pseudocyst must be distinguished from a true cystic neoplasm of the pancreas (such as a mucinous cystic neoplasm), which has malignant potential and is managed quite differently. The clinical context (a preceding attack of pancreatitis), the fluid characteristics (high amylase) and imaging features help make this distinction — an important step, because draining a cystic tumour as if it were a pseudocyst would be a serious error.

The Bottom Line

A pancreatic pseudocyst is a walled-off, epithelium-free collection of amylase-rich fluid after pancreatitis; small ones resolve, while large, symptomatic or complicated ones are drained (usually endoscopically).

Complications & Timing of Drainage

The timing of intervention matters: a pseudocyst wall needs about 4–6 weeks to mature before it can safely hold sutures or an endoscopic stent, so drainage of a stable cyst is generally deferred until then. Complications that force earlier action include infection (turning it into an abscess), haemorrhage from erosion into a splenic or gastroduodenal vessel (which may need angiographic embolisation), rupture, and gastric outlet or biliary obstruction from the enlarging cyst.

It has no epithelial lining — hence pseudo-cyst.

• Pancreatic pseudocyst = walled-off collection of pancreatic (amylase-rich) fluid with a fibrous/granulation wall (no epithelial lining), after pancreatitis/trauma, usually >4 weeks later.
• Epigastric pain, palpable mass, early satiety/nausea, persistently raised amylase.
• CT/ultrasound confirms; many small ones resolve spontaneously.
• Drain (endoscopic cystogastrostomy or surgical) if large, persistent, symptomatic or complicated (infection, haemorrhage, rupture, obstruction).