STUDY OF CLINICAL PROFILE AND TREATMENT OUTCOME IN PANCREATIC PSEUDOCYST IN TERITIARY CARE HOSPITAL

Dr.G.Mohan Reddy; Dr.K.Vidyasagar; Dr.P.Ravikaladhar Reddy

Volume : VII, Issue : XII, December - 2017

STUDY OF CLINICAL PROFILE AND TREATMENT OUTCOME IN PANCREATIC PSEUDOCYST IN TERITIARY CARE HOSPITAL

Dr. G. Mohan Reddy, Dr. K. Vidyasagar, Dr. P. Ravikaladhar Reddy

Abstract :

BACKGROUND:

Pancreatic pseudocyst, the most common cystic lesion of the pancreas, by definition is a localized collection of fluid rich in amylase within or adjacent to the pancreas in the lesser curvature enclosed by nonepitheliazed wall occurring as a result of acute or chronic pancreatitis , pancreatic trauma, pancreatic duct obstruction. Pancreatic pseudocysts are a recognized complication of 16% to 50% cases of acute pancreatitis and 20–40% cases of chronic pancreatitis¹. Recent data suggest that selected pancreatic pseudocysts may treated expectantly with a lower morbidity rate and intervention is unnecessary in selected patients with asymptomatic pseudocysts.

Until 20 years ago the most common treatment was open surgery with internal drainage, though not without significant associated morbidity and mortality. Nowadays several minimally invasive techniques are available, including percutaneous drainage endoscopic internal and laporoscopic operations.

AIM:

The aim of present study is study the clinical profile and different modes of treatments for the pancreatic pseudocysts.

MATERIALS &METHODS:

A Prospective study was done between Dec 2006 to Dec 2008 in the Dept. of Gastroenterology, Osmania General Hospital. Patients included in the study were proven to have pseudocysts by imaging investigations like ultrasound and CT scan abdomen as defined by Atlanta classification. All patients were followed for 6 months. Demographic data, etiology, length of hospital stay, laboratory parameters, investigations, recurrences, complications, were noted.

RESULTS:

In present study most common age group affected was 30–40 yrs with mean age 31.2 year. Male to female ratio was 5:1. Alcoholic pancreatitis was the most common cause of pancreatic pseudocysts (50%) followe by others /idiopathic causes (35%) followed by gallstone disease (10%).

Most patients presented with abdominal pain (87%) followed by mass (43.4%), early satiety and weight loss (39.1%) fever (30.4%) vomiting (13%).The most common location of pseudocyst was lesser sac (60%) followed by body and tail (20%) and head (17%). Out of this 10 patients achieved spontaneous remission successfully and the remaining 5 patients subsequently underwent other treatments. This constituted 66% patients remitted spontaneously.

In the present study 8 patients underwent percutaneous drainage out of these 5 were following acute pancreatitis (Degidios type 1) and 3 patients had pseudocysts following acute on chronic pancreatitis (Degidios type 2). PCD was successful in all cases constituting 100% success rate with mean duration of drainage in type 1 pseudocysts being 8 days and in type 2 pseudocysts being 10.3 days.

In the present study 2 patients underwent endoscopic transmural drainage with 100% success rate.In the present study most commonly employed surgical procedure was internal drainage in 3 of out of 5 cases (60%) one patient(20%) open drainage and one patient underwent pseudocyst excision.Among the 3 cases of internal drainage 2 patients underwent cystogastrostomy, 1 patient underwent cystodueodenostomy.

CONCLUSIONS

Alcoholic pancreatitis was the most common cause of pancreatic pseudocysts (50%) followed by others /idiopathic causes (35%) followed by gallstone disease(10%).

Small asymptomatic pseudocysts < 6 cm, were can be followed expectantly for spontaneous remission.In selective group of patients percutataneous catheter drainage of pseudocyst is more effective eg; pseudocysts following acute pancreatitis and acute on chronic pancreatitis without ductal stricture and communication. Success rate in this group is >90%.Endoscopic transmural drainage is safe and effective procedure in patients with visible bulge in to stomach and duodenum.Surgery is first choice in patients with complicated pseudocycsts and when other interventions failed to achieve remission.