A pancreatic pseudocyst is defined as an encapsulated fluid collection with a well-defined inflammatory wall with minimal or no necrosis. The diagnosis cannot be made prior to 4 wk after the onset of pancreatitis. The clinical presentation is often nonspecific, with abdominal pain being the most common symptom. If a diagnosis is suspected, contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the pseudocyst. Endoscopic ultrasound with cyst fluid analysis can be performed in cases of diagnostic uncertainty. Pseudocyst of the pancreas can lead to complications such as hemorrhage, infection, and rupture. The management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications, such as biliary or gastric outlet obstruction. Management options include endoscopic or surgical drainage. The aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions, diagnosis, and management of this condition.

The lumen-apposing metal stent is the first stent specifically designed for endoscopic ultrasound-guided transluminal drainage of extraintestinal fluid collections. With the "hot" electrocautery-enhanced delivery system, this platform marks the most recent evolutionary stage of endoscopic therapy of pancreatic fluid collections. The lumen-apposing metal stent platform has made endoscopic drainage of pancreatic fluid collections easier and safer, while serving as a port for safe entry into the cyst cavity to extend the reach of endoscopic diagnosis and therapy. Tools conceived for endoscopic ultrasound-guided transluminal intervention have emerged and are opening the door to new frontiers of endoscopic transluminal therapy.

Most pleural effusions are caused by hydrostatic and oncotic pressure imbalance, inflammation or infection, or abnormalities in lymphatic drainage. A select number of effusions are caused by fluid of extravascular origin. Some of these effusions result from complications of treatment, whereas others are a ramification of the underlying disease. The incidence, pathogenesis, clinical presentation, chest radiographic manifestations, pleural fluid analysis, diagnosis, and management are discussed.

Pseudocyst contents are not indicative of pancreatic function. We presume that the nonresolving pseudocysts did not resolve because they were noncommunicating. The question of the kinetics of secretion into pancreatic pseudocysts is still unresolved.

Pseudocysts are one of the complications of chronic pancreatitis. We wanted to investigate whether it is of any value to measure enzyme activities (amylase and lipase) in pseudocyst contents, in order to answer the following questions: Is the enzymatic activity: 1. Reproducible in consecutive punctures of the same cyst; 2. Related to cyst age; 3. Indicative for the risk of relapse; and 4. Representative of exocrine pancreatic function.

In a retrospective study we examined 28 patients with chronic pancreatitis complicated with pancreatic pseudocysts.

Reproducibility of enzyme activity in cyst juice in consecutive punctures of the same cyst was poor. We did not observe any correlation between enzyme activity and cyst age defined as the time between two cyst punctures. Enzyme activity in cyst juice was without indication for the risk of relapse. No correlation between enzyme activity and exocrine pancreatic function was found. The pseudocyst contents are not pancreatic juice in the common sense of the word

This retrospective study reviews our five-year experience with the management of cases of pancreatic pseudocyst. The etiological pattern, clinical presentation, diagnostic methods, and therapeutic measures are described. Biliary pancreatitis was the leading cause in our series, accounting for 45% of the cases. The majority of patients (69%) presented with acute pancreatitis, and pseudocyst subsequently developed during hospitalization. Twenty-one percent presented pancreatic pseudocyst associated with recurrent abdominal pain. No mass palpable in 48% of the patients. Ultrasonography and computed tomographic (CT) scanning were the two most useful investigations, yielding correct diagnosis in 95% and 100% of the cases, respectively. The pseudocyst completely resolved in 24% of the patients. Patients who presented with acute pancreatitis were initially treated conservatively until the cyst was mature enough for surgical intervention. Those who presented with well-developed cysts were operated on much earlier, after a mean period of 16.5 days. Interval drainage was used in 52% of the patients. The main complications were chest infection (31%) and wound infection (9.5%). The overall mortality was 5%.

This report describes a case of intraperitoneal rupture of a pancreatic pseudocyst (PPC) following blunt abdominal trauma. Cause of the pseudocyst was likely alcoholic pancreatitis. Peritoneal aspiration of hemorrhagic fluid prompted laparotomy and led to diagnosis. Trauma-induced intraperitoneal rupture of a preexisting PPC has been rarely reported.

Enlarging pancreatic pseudocysts, as well as those that develop complications such as bleeding, leak, infection, and intestinal or biliary obstruction, require treatment. This treatment is usually surgical and consists of internal or external drainage or, less commonly, excision. Transcutaneous aspiration with or without drain placement has also been reported. We describe four cases of endoscopic cystogastrostomy and cystoduodenostomy undertaken in high risk patients who had either failed previous surgery (two) or were initially refused surgery because of prohibitive operative risk (two). Technique, limitations, and potential use of this procedure are discussed.

Pseudocysts of the pancreas continue to pose a dilemma to both the internist and the surgeon alike when attempting to establish a rational means of management. Although ardent strides have been made in the realm of diagnosis and follow-up with the advent of ultrasonography, mortality and morbidity have not changed appreciably over the past 20 years. Although internal drainage is the desired method of surgical management, not all pseudocysts are amenable to this approach. Thus, the operative procedure should be strictly tailored to the patient's particular clinical situation so that acceptable long-term results can usually be obtained. By incorporating parenteral hyperalimentation into the immediate postoperative treatment period, it is postulated that surgical morbidity can be decreased. It has been unequivocally demonstrated that spontaneous resolution does occur in a significant number of patients, but until a reliable means of assessing the natural history of a particular pseudocyst is established, these lesions of the pancreas remain a surgical problem.

Prior to the advent of cross-sectional imaging, the diagnosis of pancreatic disease and its extent could not be obtained without surgery. Ultrasound is a noninvasive modality which has been evolving over the last 7-10 years. The purpose of this review will be to determine the present status of ultrasound in the evaluation of adult and pediatric pancreatic disease. Also, its role with regard to computed tomography (CT) and interventional techniques will be discussed.