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PANCREATIC CYSTS

Pancreatic cysts are closed saclike pockets filled with fluid located on or in the pancreas. These cysts can be either benign (non-cancerous) or malignant (cancerous). The pancreatic cysts are found incidentally when imaging testing and ultrasound of the abdomen is performed for other health conditions. Most of the cysts are asymptomatic as they do not cause any symptoms, however, when larger and expanding cysts compress the surrounding tissues, symptoms are seen. Pancreatic cysts also result from rare diseases, such as von Hippel-Lindau disease.

Types of pancreatic cysts

There are nearly 20 types of pancreatic cysts. The common types include:

  • Pseudocysts – These are benign cysts resulting from pancreatic inflammation; these cysts do not require treatment as they resolve on their own
  • Serous Cystadenomas (SCAs) – These are benign cysts containing fluid with thick, fibrous walls. They usually do not require any treatment but may cause pain, jaundice as they grow
  • Intraductal Papillary Mucinous Neoplasms (IPMNs) – These are the most common type of pancreatic cysts which develop within the ducts connecting pancreas to the intestines. The cells of the cysts produce a lot of proteins that form mucus.
  • Mucinous Cysts– These are precancerous growths that start in the body and tail of the pancreas and more commonly seen in women rather than men. These cysts should be removed surgically.

Signs and symptoms

Pancreatic cysts are usually asymptomatic or may produce mild to moderate symptoms. The common symptoms which occur after a pancreatitis attack include:

  • Severe and persistent pain in the abdomen, sometimes at the back
  • Nausea and vomiting
  • Abdominal bloating
  • A mass of tissue can be felt in the upper abdomen

Some cysts may become infected due to which the patient develops fever, persistent and severe abdominal pain, weak and rapid heartbeat, decreased consciousness, and blood in vomiting. In such instances, the patient should be taken to the doctor immediately.

Causes

The exact cause of pancreatic cyst is still not known. Researchers believe that few cysts are associated with rare illness such as von Hippel-Lindau disease, which is a genetic disorder affecting the pancreas. Pseudocysts often result from pancreatitis which is often caused by alcoholism, injury to the abdomen, gallstones, and trauma.

Complications

Pancreatic cysts, if not treated on time may develop a certain complication like:

  • Infection, that leads to pancreatic abscess
  • Breaking open and bleeding of the cysts which may be life-threatening
  • Obstructive jaundice may occur when a large cyst blocks the common bile duct, causing yellowing of the skin, mucous membrane, and eyes
  • Increase in blood pressure of the portal veins requiring surgery

Diagnosis

 

Pancreatic cysts are hard to diagnose as the symptoms resemble many other disease conditions. The medical history of the patient is first assessed and other diagnostic tests are recommended:

  • Blood tests- to determine if the cysts are benign or cancerous.
  • CT scan – to know about the size and structure of the pancreatic cyst
  • MRI scan – to get detailed information about the cyst, including whether the components of the cysts cause cancer
  • Endoscopic ultrasound – fluid is collected from the cysts to check the possible signs of cancer

Treatment

Pancreatic cysts are benign and usually do not require treatment. But if the symptoms are persistent, the patient may develop complications and hence certain treatment options are recommended.

Drainage

Drainage of the cysts is done if they are more than 6 cm in size. An endoscope, equipped with a needle is passed through the mouth into your stomach and small intestine to drain the cyst.

Surgery

This is recommended if the cysts are larger with a solid component and if the cysts are growing and causing pain. The whole of pancreatic cysts are removed, either via open surgery which or laparoscopic surgery. Open surgical procedures include:

  • Whipple procedure- cysts from the head of the pancreas are removed.
  • Distal pancreatectomy- cysts located in the tail or left part of the pancreas are removed by taking out the tail of the pancreas and sometimes spleen
  • Total pancreatectomy-whole of the pancreas are removed if the cysts have affected many parts of it

Minimally invasive procedures include laparoscopy in which a surgeon inserts a thin, lighted tube through an incision in the abdominal wall and removes the cysts.

Prevention

The risk of pancreatic cysts can be reduced by minimizing or avoiding alcohol intake. Alcohol intake may be directly responsible for pancreatitis and indirectly for the formation of pancreatic cysts. If the cysts are due to the formation of gall stones, gall bladder should be removed.

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