Influence of the etiology of pancreatitis on the natural history of pancreatic pseudocysts

Article Abstract:

Treatment of pancreatic pseudocysts combines close observation and, at the appropriate time, surgical drainage of the pseudocyst (a dilation resembling a cyst). These 'false' cysts are associated with pancreatitis, or inflammation of the pancreas. They resolve spontaneously in up to 50 percent of cases. It is believed that the development and progression of pancreatic pseudocysts are dependent on their initial size and whether or not they are chronic. A study was undertaken of 90 patients with pancreatic pseudocysts to evaluate the cause of the underlying pancreatic disease as a possible factor in the further development and progression of the pseudocysts. A total of 57 patients with acute pancreatitis were assessed: 15 cases of acute pancreatitis were due to alcohol abuse; 13 occurred after surgery; 12 were due to biliary disease; and 16 cases were attributed to other causes. Chronic pancreatitis was present in 33 patients: 27 cases were due to chronic alcohol intake and 6 were due to other causes. Patients with acute pancreatitis had multiple pseudocysts significantly more often than those with chronic pancreatitis (47 percent versus 19 percent). Overall, 10 patients (11 percent) had spontaneous resolution of pseudocysts; no patient with biliary or postoperative pancreatitis experienced spontaneous resolution. There were significantly more deaths in the group of patients with postoperative pancreatitis (27 percent compared with 7 percent for all other groups). Chronic pancreatitis was associated with smaller pseudocysts; however, about the same percent of patients with chronic pancreatitis and acute pancreatitis required surgery (56 percent and 58 percent, respectively). Outcome was not influenced by cyst size or presentation. These findings show that the cause of pancreatitis is more important in determining the outcome of pseudocyst than the size or presentation of pancreatic pseudocyst. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Prognosis, Pancreatic diseases, Cysts, Pancreatic cysts

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Can markers for pancreatic necrosis be used as indicators for surgery?

Article Abstract:

Severe acute pancreatitis, an inflammatory condition of the pancreas that is generally the result of damage to the biliary tract, is often fatal. Those patients who survive the initial disease are at risk of death from sepsis (contamination or poisoning of the system by infection); secondary infection of necrotic (dead) pancreas tissue causes death in 30 to 50 percent of patients. Early detection of pancreatic necrosis is important. Various markers have been associated with the course of acute pancreatitis; these are C-reactive protein, alpha-1 antitrypsin, and alpha-2 macroglobulin. A study was undertaken to determine if a specific value of one of these markers could predict the presence of a pancreatic collection (abscess, pseudocyst or pancreatic necrosis) requiring surgery. Forty-five consecutive patients with acute pancreatitis were studied. Serial blood levels of these three markers were obtained. Thirteen patients developed pancreatic collection and required surgery for drainage; three patients died. Over the seven days that blood samples were taken, there was no noticeable change in the levels of alpha-1 antitrypsin or alpha-2 macroglobulin. C-reactive protein levels reached a peak the day after admission and then declined. There was a trend toward positive serum markers being associated with pancreatic collection, but this was not statistically significant. It is concluded that these markers are not sensitive enough to predict if a patient will or will not require surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Diagnosis, Pancreas, Necrosis

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