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of or involving the pancreas; "pancreatic cancer"

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/04 12:08:44」(JST)

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A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen.

Pancreatic pseudocysts are usually complications of pancreatitis,^[1] although in children they frequently occur following abdominal trauma. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses. The prefix pseudo- (Greek for "false") distinguishes them from true cysts, which are lined by epithelium; pseudocysts are lined with granulation tissue.

Pathophysiology

Acute pancreatitis results, amongst other things, in the disruption of pancreatic parenchyma and the ductal system. This results in extravasation of pancreatic enzymes which in turn digest the adjoining tissues. This results in a collection of fluid containing pancreatic enzymes, hemolysed blood and necrotic debris around the pancreas. The lesser sac being a potential space, the fluid collects here preferentially. This is called an acute pancreatic collection. Some of these collections resolve on their own as the patient recovers from the acute episode. However, others become more organized and get walled-off within a thick wall of granulation tissue and fibrosis. This takes several weeks to occur and results in a pancreatic pseudocyst.

Diagnosis

The questions that need to be answered are:

where, how big and how many?
is there a communication with the pancreatic ductal system? Draining such a pseudocyst carries an increased risk of pancreatic fistula.
what are the percentages of pseudocyst forming in chronic pancreatitis

The most useful imaging tools are

Ultrasonography^[2] - The role of ultrasonography in imaging the pancreas is limited by patient habitus, operator experience and the fact that the pancreas lies behind the stomach (and so a gas-filled stomach will obscure the pancreas).
Computerized tomography^[3] - This is the gold standard for initial assessment and follow-up.

Large Pancreatic Pseudocyst

Magnetic resonance cholangiopancreatography (MRCP) - to establish the relationship of the pseudocyst to the pancreatic ducts

Treatment

A small pseudocyst that is not causing any symptoms may be managed conservatively. However, a large proportion of them will need some form of treatment.

The majority of patients who require treatment for their pseudocysts are treated by surgery.

In the surgical procedure for the treatment of pseudocyst a connection is created between the cyst and an adjacent intestinal organ to which the cyst is adherent to such as the stomach. This connection allows the cyst to drain into the stomach. Since in many patients the cyst is formed by continuous leakage of pancreatic juice into the cyst this allows the pancreatic juice to be rerouted into the intestine through the connection.

Cystogastrostomy: In this surgical procedure a connection is created between the back wall of the stomach and the cyst such that the cyst drains into the stomach.
Cystjejunostomy: In this procedure a connection is created between the cyst and the small intestine so that the cyst fluid directly into the small intestine.
Cystduodenostomy: In this procedure a connection is created between the duodenum (the first part of the intestine) and the cyst to allow drainage of the cyst content into duodenum.

The type of surgical procedure depends on the location of the cyst. For cysts that occur in the body and tail of the pancreas either a cystjejunostomy or cystgastrostomy is performed depending on the location of the cyst in the abdomen. For pseudocysts that occur in the head of the pancreas a cystduodenostomy is usually performed.

Complications

Complication of pancreatic pseudocyst include infection, hemorrhage, obstruction and rupture. For obstruction, it can cause compression in the GI tract from the stomach to colon, compression in urinary system, biliary system, and arteriovenous system.

References

^ Habashi S, Draganov PV (January 2009). "Pancreatic pseudocyst". World J. Gastroenterol. 15 (1): 38–47. doi:10.3748/wjg.15.38. PMC 2653285. PMID 19115466.
^ Aghdassi AA, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM (2006). "Pancreatic pseudocysts - when and how to treat?". HPB (Oxford) 8 (6): 432–41. doi:10.1080/13651820600748012. PMC 2020756. PMID 18333098.
^ Aghdassi A, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM (March 2008). "Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis". Pancreas 36 (2): 105–12. doi:10.1097/MPA.0b013e31815a8887. PMID 18376299.

UpToDate Contents

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1. 仮性膵嚢胞の診断およびマネージメント diagnosis and management of pseudocysts of the pancreas
2. 仮性膵嚢胞の内視鏡によるマネージメント：効果および合併症 endoscopic management of pseudocysts of the pancreas efficacy and complications
3. 膵嚢胞の分類 classification of pancreatic cysts
4. 慢性膵炎の合併症 complications of chronic pancreatitis
5. 仮性膵嚢胞の内視鏡操作：手技 endoscopic management of pseudocysts of the pancreas technique

English Journal

Imaging of acute pancreatitis and its complications. Part 2: Complications of acute pancreatitis.

Türkvatan A1, Erden A2, Türkoğlu MA3, Seçil M4, Yüce G5.Author information 1Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey. Electronic address: aturkvatan@yahoo.com.2Department of Radiology, Ankara University School of Medicine, Talatpaşa Street, 06100 Sıhhiye, Ankara, Turkey.3Department of General Surgery, Akdeniz University School of Medicine, Dumlupınar street, Antalya, Turkey.4Department of Radiology, Dokuz Eylul University School of Medicine, Cumhuriyet street, İzmir, Turkey.5Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey.AbstractThe Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.
Diagnostic and interventional imaging.Diagn Interv Imaging.2014 Apr 1. pii: S2211-5684(13)00426-9. doi: 10.1016/j.diii.2013.12.018. [Epub ahead of print]
The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus st
PMID 24703377

Vascular endothelial growth factor, a novel and highly accurate pancreatic fluid biomarker for serous pancreatic cysts.

Yip-Schneider MT1, Wu H2, Dumas RP2, Hancock BA2, Agaram N3, Radovich M2, Schmidt CM4.Author information 1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Electronic address: maxschmi@iupui.edu.2Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.3Department of Pathology, Indiana University School of Medicine, Indianapolis, IN.4Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Biochemistry/Molecular Biology, Indiana University School of Medicine, Indianapolis, IN; Walther Oncology Center, Indiana University School of Medicine, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN; Richard L Roudebush VA Medical Center, Indianapolis, IN.AbstractBACKGROUND: Mucinous pancreatic cysts (intraductal papillary mucinous neoplasm and mucinous cystic neoplasm) have the potential to progress to invasive pancreatic adenocarcinoma, presenting an opportunity for early detection, prevention, and cure. Serous cystic neoplasms (SCN) have no malignant potential, but can mimic mucinous pancreatic cysts on imaging. Therefore, identification of biomarkers that can distinguish between cystic lesions is critically important. We hypothesize that vascular endothelial growth factor (VEGF)-A levels in pancreatic fluid correlate with pathologic diagnosis.
Journal of the American College of Surgeons.J Am Coll Surg.2014 Apr;218(4):608-17. doi: 10.1016/j.jamcollsurg.2013.12.019. Epub 2013 Dec 24.
BACKGROUND: Mucinous pancreatic cysts (intraductal papillary mucinous neoplasm and mucinous cystic neoplasm) have the potential to progress to invasive pancreatic adenocarcinoma, presenting an opportunity for early detection, prevention, and cure. Serous cystic neoplasms (SCN) have no malignant pote
PMID 24491241

Gastric Obstruction Due to Intramural Pseudocyst Associated with Heterotopic Pancreas.

Bryan DS1, Waxman I, Matthews JB.Author information 1Biological Sciences Division, Department of Surgery, University of Chicago, Chicago, IL, USA.AbstractAn unusual case of gastric outlet obstruction caused by a gastric intramural pseudocyst associated with heterotopic pancreas is illustrated. Heterotopic pancreas is defined as the presence of aberrant pancreatic tissue that is anatomically and vascularly distinct from the pancreas itself (Liu et al. Am Surg. 78:E141-3, 2012). Heterotopic pancreatic tissue has been reported in many locations along the gastrointestinal tract, identified most commonly in the stomach where it is usually an asymptomatic anatomic curiosity than a source of clinical concern. We encountered an unusual instance in which heterotopic pancreas in the distal stomach was associated with heterotopic pancreatitis and intramural pseudocyst formation that led to gastric obstruction.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.J Gastrointest Surg.2014 Mar 26. [Epub ahead of print]
An unusual case of gastric outlet obstruction caused by a gastric intramural pseudocyst associated with heterotopic pancreas is illustrated. Heterotopic pancreas is defined as the presence of aberrant pancreatic tissue that is anatomically and vascularly distinct from the pancreas itself (Liu et al.
PMID 24668368

Japanese Journal

症例報告肝内胆汁性胞および膵仮性胞を形成し経皮的ドレナージが有効であった外傷性肝損傷および膵損傷の1例

川久保尚徳,林田真,松浦俊治 [他]
日本小児外科学会雑誌 48(6), 931-936, 2012-10
NAID 40019466108

内視鏡超音波ガイド下経胃的膵仮性嚢胞ドレナージにより治療した腎被膜下嚢胞の1例

木村博子,神波大己,熱田雄 [他]
泌尿器科紀要 58(8), 421-424, 2012-08
… He had histories of pancreatic pseudocyst caused by alcoholic pancreatitis and right nephrectomy due to renal cell carcinoma. … Computed tomographic scan demonstrated that a subcapsular renal cyst appeared adjacent to the pancreatic pseudocyst and compressed the parenchyma of the left kidney. …
NAID 40019387933

Related Pictures

★リンクテーブル★

リンク元	「膵仮性嚢胞」「仮性膵嚢胞」
関連記事	「pancreatic」「pseudocyst」

「膵仮性嚢胞」

Pancreatic pseudocyst
	A pancreatic pseudocyst as seen on CT
Classification and external resources
ICD-10	K86.3
ICD-9	577.2
DiseasesDB	9530
MedlinePlus	000272
eMedicine	med/2674 radio/576
MeSH	D010192