Pancreatic pseudocyst: Causes, Symptoms, Treatment, and Cost

A fluid-filled sac called a pancreatic pseudocyst develops in the pancreas as a result of inflammation or damage.It is not a true cyst, but rather a collection of pancreatic enzymes, tissue, and other fluids that have leaked out of the gland and surrounded it.

Here are the different types of pancreatic pseudocysts:

• Acute peripancreatic fluid collection: This type of pseudocyst develops within the first four weeks of acute pancreatitis and is often a result of pancreatic duct disruption or leak.
• Post-necrotic pancreatic pseudocyst: This type of pseudocyst usually develops after severe necrotizing pancreatitis, where there is extensive tissue destruction and necrosis.
• Retention cyst: This type of pseudocyst develops due to an obstruction in the pancreatic duct that causes the accumulation of pancreatic secretions.
• True cyst: Unlike other types of pancreatic pseudocysts, this type of cyst has an epithelial lining and is considered a true cyst.
• Intraductal papillary mucinous neoplasm (IPMN)-related pseudocyst: This type of pseudocyst develops due to the dilation of the pancreatic duct as a result of IPMN, a premalignant condition that can lead to pancreatic cancer.
• Traumatic pancreatic pseudocyst: This type of pseudocyst develops due to blunt or penetrating trauma to the pancreas.

Here are some of the most common causes of pancreatic pseudocyst:

• Acute or chronic pancreatitis: Pancreatitis, whether acute or chronic, can cause pseudocysts to form due to damage to the pancreatic ducts that lead to the leakage of pancreatic fluid.
• Pancreatic trauma: Blunt or penetrating trauma to the pancreas can result in the formation of pseudocysts.
• Gallstones: Gallstones that become lodged in the bile duct can cause inflammation and obstruction of the pancreatic duct, leading to the accumulation of pancreatic fluid and the development of pseudocysts.
• Pancreatic cancer: In rare cases, pseudocysts can be caused by pancreatic cancer, especially in cases of intraductal papillary mucinous neoplasms (IPMNs).
• Abdominal surgery: Abdominal surgeries, particularly those involving the pancreas, can lead to the formation of pseudocysts due to damage to the pancreatic ducts.
• Chronic alcoholism: Long-term heavy alcohol consumption can cause chronic pancreatitis, leading to the development of pseudocysts.
• Genetic disorders: Certain genetic disorders, such as hereditary pancreatitis, can increase the risk of developing pseudocysts.

Some common symptoms of pancreatic pseudocyst include:

• Abdominal pain: This is the most common symptom of the pancreatic pseudocyst, and it may be a dull or sharp pain that is felt in the upper abdomen.
• Nausea and vomiting: Some people with pancreatic pseudocyst may experience nausea and vomiting, particularly if the pseudocyst is causing digestive system problems.
• Loss of appetite: People with pancreatic pseudocyst may experience a loss of appetite due to abdominal discomfort.
• Jaundice: If the pseudocyst is compressing the bile duct, it can cause jaundice, which is characterised by yellowing of the skin and eyes.
• Fever: If the pseudocyst becomes infected, it can cause fever and other signs of infection.
• Weight loss: Chronic symptoms associated with pancreatic pseudocyst can cause weight loss over time.
• Pancreatitis: In some cases, the pancreatic pseudocyst can cause pancreatitis, which is characterised by severe abdominal pain, fever, and nausea.

Several things can be done to reduce the risk of developing this condition, including:

• Manage underlying conditions: Pancreatitis, gallstones, and other conditions that increase the risk of pancreaticpseudocyst should be managed and treated promptly to prevent further damage to the pancreas.
• Avoid heavy alcohol consumption: Chronic alcohol consumption can lead to pancreatitis, which can increase the risk of developing pancreatic pseudocysts.
• Practise good nutrition: Eating a healthy, balanced diet that is low in fat and sugar can help reduce the risk of developing pancreatitis and other conditions that increase the risk of pancreatic pseudocyst.
• Quit smoking: Quitting smoking may lower the chance of getting pancreatitis, which is a disorder that is influenced by smoking.
• Get regular check-ups: Regular check-ups and imaging tests can help detect pancreatic pseudocysts early and prevent complications.
• Avoid abdominal trauma: Avoiding trauma to the abdomen, such as through the use of seat belts and protective gear, can help reduce the risk of developing pancreatic pseudocyst.

Pancreatic pseudocyst may be identified using a number of diagnostic tests, such as:

• Imaging tests:The pancreas may be seen and a pseudocyst can be found using imaging procedures such a CT scan, MRI, and ultrasound. Endoscopic ultrasound (EUS): This is a specialised type of ultrasound that uses a flexible endoscope to obtain high-resolution images of the pancreas and surrounding structures.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): This test combines endoscopy and X-rays to visualise the pancreatic and bile ducts, and it can be used to detect the presence of a pseudocyst or complications such as obstruction.
• Blood tests: Blood tests can be used to evaluate the pancreatic function and detect elevated levels of enzymes that may indicate pancreatic damage or inflammation.
• Biopsy: In some cases, a biopsy may be performed to confirm the presence of a pseudocyst and rule out other conditions such as pancreatic cancer. Laparoscopy: In this minimally invasive surgery, the pancreas and surrounding organs are seen by inserting a thin tube with a camera via a tiny abdominal incision.

Some possible complications of pancreatic pseudocysts include:

• Infection: Pseudocysts can become infected, leading to symptoms such as fever, chills, and increased pain.
• Rupture: Pseudocysts can rupture, causing severe abdominal pain, infection, and even death.
• Obstruction: Pseudocysts can press on nearby organs, obstructing the bile duct or duodenum, which can lead to jaundice, nausea, vomiting, and other digestive problems.
• Haemorrhage: Pseudocysts can cause bleeding from nearby blood vessels, leading to blood loss and anaemia.
• Pancreatic duct obstruction: Pseudocysts can block the pancreatic duct, which can lead to pancreatitis, a condition where the pancreas becomes inflamed and damaged.
• Chronic pancreatitis: Long-standing pseudocysts can lead to chronic inflammation and damage to the pancreas, which can cause chronic pancreatitis

Here are some possible Home remedies:

• Triphala: Triphala is an herbal preparation made from three fruits, amla, haritaki, and bibhitaki.It is said to have anti-inflammatory, antioxidant, and detoxifying properties.properties. Triphala can be taken orally to help manage pancreatic pseudocysts.
• Kutajarishta: The bark of the kutaja tree is used to make the Ayurveda tonic known as kutajarishta. It is thought to possess antibacterial and anti-inflammatory characteristics, which may aid in the treatment of pancreatic pseudocysts. It is usually taken orally, after consulting with a qualified Ayurvedic practitioner.
• Turmeric: Ayurvedic medicine often employs the spice turmeric. Anti-inflammatory and antioxidant qualities are thought to exist in it, which may aid in the treatment of pancreatic pseudocysts. You may consume turmeric or cook with it.
• Aloe vera: Aloe vera is a plant that is widely used in Ayurvedic medicine for its healing properties.Anti-inflammatory and antioxidant qualities are thought to exist in it, which may aid in the treatment of pancreatic pseudocysts.Aloe vera can be taken orally or applied topically to the affected area.
• Yoga:Yoga is a popular mind-body technique in Ayurveda medicine.It is believed to have a calming effect on the body and mind, which may help in managing pancreatic pseudocysts. Certain yoga postures, such as the seated forward bend and the bridge pose, may be particularly helpful for managing pancreatic pseudocysts.

Here are some points on what to eat in the pancreatic pseudocyst:

• Clear liquids: Initially, clear liquids such as water, tea, and broth may be recommended to avoid putting too much strain on the pancreas.
• Low-fat foods: As the condition progresses, low-fat foods such as skinless chicken, fish, and steamed vegetables may be added to the diet.
• Soft, easy-to-digest foods: Soft and easy-to-digest foods such as boiled eggs, cooked cereals, and mashed potatoes are recommended.

This food should be avoided when you are suffering from Pancreatic pseudocyst;

• High-fat foods: Pancreatic pseudocyst can cause partial or complete blockage of the pancreatic duct, and eating high-fat foods can worsen the condition by increasing the secretion of pancreatic juice, thereby increasing the pressure in the duct.
• Spicy foods: Spicy foods can cause irritation and inflammation in the digestive tract, which can aggravate the pancreatic pseudocyst.
• Alcohol: Alcohol is known to be a major cause of pancreatitis, which can lead to the formation of pancreatic pseudocysts. Thus drinking alcohol during treatment is not recommended.
• Caffeine: Caffeine can stimulate the production of stomach acid, and it can lead to inflammation in the digestive system if consumed in excess. So caffeine should be avoided.
• Fried foods: Fried foods can cause indigestion, and they are also high in fat content. So they should be avoided during treatment.
• Red meat and processed foods: Red meat and processed foods are high in fat and can cause inflammation in the gut. Hence they should be avoided during treatment.

Pancreatic pseudocysts may be treated using a number of different methods. They consist of:

• Percutaneous drainage: In this procedure, a needle is inserted into the pseudocyst through the skin, and the fluid is drained out.With local anaesthesia, this minimally invasive treatment may be carried out.
• Endoscopic drainage: In this procedure, an endoscope is used to access the pseudocyst through the mouth and stomach. To enable fluid drainage, a stent is inserted.
• Laparoscopic drainage:Small abdominal incisions are created during this treatment, and a laparoscope is utilised to see the pseudocyst.The fluid is drained, and the cyst wall is removed.
• vOpen surgery: In cases where the pseudocyst is large or complicated, open surgery may be required. In order to perform this, a bigger abdominal incision must be made, and the cyst wall must be removed.

Pancreatic pseudocysts are usually managed by gastroenterologists, pancreatic surgeons, or interventional radiologists.

Here are some medications that may be used in the management of pancreatic pseudocysts:

• Pain relievers: Pain is a common symptom of pancreatic pseudocysts, and pain relievers such as acetaminophen, ibuprofen, or opioids may be used to manage the pain.
• Proton pump inhibitors (PPIs): PPIs are drugs that lessen the quantity of stomach acid generated.They may be used to prevent or treat inflammation of the pancreas that can occur with pancreatic pseudocysts.
• Antibiotics: Infections associated with pancreatic pseudocysts may need antibiotic treatment. Pancreatic enzyme supplements: Pancreatic enzyme supplements may be prescribed to help improve digestion in patients with pancreatic pseudocysts.
• Antiemetics: Antiemetics are medications used to treat nausea and vomiting that can occur with pancreatic pseudocysts.
• Octreotide: Octreotide is a medication that can reduce the production of certain hormones in the pancreas, which can help manage the symptoms of pancreatic pseudocysts.

The recovery time from pancreatic pseudocyst depends on the size, location, and underlying cause of the cyst, as well as the patient's overall health. Depending on the intricacy of the treatment and the patient's general condition, the recovery period might be anywhere from a few days and several weeks.

It depends on the particulars of the procedure and the case in question. Some people may find that the results of the surgery are permanent and they do not experience any further complications related to the pseudocyst. However, in some cases, the pseudocyst may return or other complications may arise that require additional treatment. It is important to follow the post-operative instructions provided by the healthcare team to maximise the chances of a successful outcome.

Here are some medications that may be used in the management of pancreatic pseudocysts:

• Pain relievers: Pain is a common symptom of pancreatic pseudocysts, and pain relievers such as acetaminophen, ibuprofen, or opioids may be used to manage the pain.
• Proton pump inhibitors (PPIs): PPIs are drugs that lessen the quantity of stomach acid generated.They may be used to prevent or treat inflammation of the pancreas that can occur with pancreatic pseudocysts.
• Antibiotics: Infections associated with pancreatic pseudocysts may need antibiotic treatment. Pancreatic enzyme supplements: Pancreatic enzyme supplements may be prescribed to help improve digestion in patients with pancreatic pseudocysts.
• Antiemetics: Antiemetics are medications used to treat nausea and vomiting that can occur with pancreatic pseudocysts.
• Octreotide: Octreotide is a medication that can reduce the production of certain hormones in the pancreas, which can help manage the symptoms of pancreatic pseudocysts.

In general, the cost of treatment can range from Rs. 50,000 to Rs. 3,00,000 or more. The cost of surgical intervention or endoscopic procedures is usually higher than that of medication-based management.

Depending on the kind of therapy used, the management of pancreatic pseudocysts may result in a variety of negative effects. Here are some possible side effects associated with each treatment option:

• Surgery: Surgical removal of a pancreatic pseudocyst can result in bleeding, infection, or damage to other organs.
• Endoscopic drainage: This procedure involves using an endoscope to drain the pseudocyst, and possible side effects include infection, bleeding, or perforation of the intestine or stomach.
• Percutaneous drainage: This approach involves using a needle to drain the pseudocyst through the skin, and potential side effects may include bleeding, infection, or damage to nearby organs.
• Chemical drainage: This procedure involves using chemicals to dissolve the pseudocyst, and possible side effects include irritation or damage to surrounding tissue.