- Steven D Freedman, MD, PhD
- Christopher E Forsmark, MD
- Section Editor:
- David C Whitcomb, MD, PhD
- Deputy Editor:
- Shilpa Grover, MD, MPH, AGAF
INTRODUCTIONChronic pancreatitis is an inflammatory condition that results in permanent structural changes in the pancreas, which can lead to impairment of exocrine and endocrine functions. This topic will review the complications of chronic pancreatitis. The clinical manifestations, diagnosis, and management of chronic pancreatitis are discussed in detail separately. (See "Chronic pancreatitis: Clinical manifestations and diagnosis in adults".)
PANCREATIC DUCT DISRUPTION
Pseudocysts — Pseudocysts develop in approximately 10 percent of patients with chronic pancreatitis. They can be induced by an acute exacerbation of pancreatitis or occur as a result of ductal disruption. Pseudocysts are mature fluid collections, have a well-defined wall (although without a true epithelial lining) visible on computed tomography (CT) or magnetic resonance imaging (MRI), and do not contain solid material or pancreatic necrosis. Most pseudocysts communicate with the pancreatic ductal system and contain high concentrations of digestive enzymes. The walls of pseudocysts are formed by granulation tissue and by adjacent structures such as the stomach, transverse mesocolon, gastrocolic omentum, and pancreas (image 1). (See "Management of pancreatic pseudocysts and walled-off pancreatic necrosis", section on 'Etiology and definitions'.)
Clinical manifestations — Most pseudocysts are asymptomatic, but may produce symptoms such as abdominal pain, weight loss, early satiety or jaundice due to gastric outlet, and intestinal or biliary obstruction due to mass effect. Pancreatic pseudocysts are sterile but may become infected. Infection, usually with gut flora, occurs in up to 10 percent of pseudocysts. Signs of an infection include fever, hypotension, and leukocytosis. If left untreated, this may progress to peritonitis and/or systemic sepsis.
Diagnosis — The diagnosis of a pancreatic pseudocyst is usually made by the finding of an intra- or peripancreatic encapsulated fluid collection on imaging in a patient with a history of chronic pancreatitis, or in a patient who has recovered from acute pancreatitis. Pancreatic pseudocysts may be seen on transabdominal ultrasound, but contrast-enhanced CT or MRI is typically obtained to confirm the diagnosis and to further classify the fluid collection. Pseudocysts do not contain solid material on imaging. If the diagnosis is uncertain, either because the clinical setting is unclear or when imaging findings are atypical, diagnostic endoscopic ultrasound can be performed with sampling of the fluid collection and cyst wall. The diagnosis of pancreatic pseudocysts and the differential diagnosis include a variety of other pancreatic cystic neoplasms. (See "Classification of pancreatic cysts" and "Management of pancreatic pseudocysts and walled-off pancreatic necrosis", section on 'Differential diagnosis' and "Management of pancreatic pseudocysts and walled-off pancreatic necrosis", section on 'Diagnostic evaluation'.)
Differential diagnosis — The differential diagnosis of a pancreatic pseudocyst includes pancreatic cystic neoplasms, cystic degeneration of a solid pancreatic tumor, and rare non-neoplastic pancreatic cysts (eg, retention cysts). These are discussed in detail separately. (See "Management of pancreatic pseudocysts and walled-off pancreatic necrosis", section on 'Differential diagnosis'.)
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