Answers
What is a pancreatic pseudocyst or walled-off necrosis?
Short answer
After an attack of acute pancreatitis, fluid or dead tissue can collect around the pancreas. After about four weeks, a wall forms around it: a pseudocyst if it is mostly fluid, or walled-off necrosis if it contains dead tissue. Many settle on their own. Those causing pain, infection or blockage can usually be drained through an endoscope, guided by EUS.
Symptoms that need attention
- Ongoing belly pain or fullness weeks after pancreatitis
- Vomiting or not being able to eat, from pressure on the stomach
- Fever, which may mean the collection is infected
- Jaundice from pressure on the bile duct
Tests
A CT or MRI scan shows the size and contents of the collection. EUS shows how much solid material is inside and the safest place to drain it.
Treatment
Drainage is best done after the wall has matured, usually about four weeks after the attack, unless infection needs earlier action.
- Collections that cause no symptoms are often just watched
- EUS-guided drainage: a stent is placed between the stomach and the collection, so it drains into the stomach without any cut on the belly
- Walled-off necrosis may need the dead tissue to be cleared through the stent (endoscopic necrosectomy), sometimes in more than one session
- Antibiotics if infected, good nutrition, and treating the cause of pancreatitis, such as gallstones or alcohol
When to seek urgent care
High fever, severe pain, vomiting blood, black stools or fainting after pancreatitis need emergency care straight away. Call 112.
Food during recovery
Eat more
- Eating by mouth as early as possible, starting with soft, low-fat food
- Small, frequent meals with protein: dal, curd, paneer, eggs
- Feeding through a tube into the intestine if eating is not possible
Cut down
- Alcohol, completely
- Large, fatty meals while recovering
- Sugary food if blood sugar has risen
Good to know
- Early feeding helps the gut and lowers the risk of infection.
- If gallstones caused the pancreatitis, gallbladder removal is planned to prevent another attack.
Common questions
Will the collection go away on its own?
Many do, especially smaller ones without symptoms. Drainage is needed only when they cause pain, infection, vomiting or jaundice.
Can a pseudocyst become cancer?
No. A pseudocyst is not a tumour. But some cystic tumours of the pancreas can look similar, which is why EUS is sometimes used to tell them apart.
How long do the stents stay after drainage?
Usually a few weeks. A scan is done to check the collection has gone, and then the stents are removed through an endoscope.