Management options for pancreatic pseudocysts

Between July 1987 and February 1990, 42 patients with pancreatic pseudocysts were treated. In 83% the pseudocyst was related to alcohol. Patients were managed by observation (7), surgical external drainage (7), and internal drainage (12). Fifteen patients were treated by ultrasound guided percutaneous catheter drainage (UGPCD) with apparent success in 67%. In 5 of these UGPCD was abandoned because of either prolonged drainage or infection of the pseudocyst. In patients with recurrent pseudocysts or in those with failed UGPCD, the cystic collections were successfully drained internally in 16 out of 17 patients (94%). Internal drainage appears to be acceptable treatment for mature pseudocysts, recurrent pseudocysts or for failed UGPCD, provided there is no downstream pancreatic duct obstruction or duct dilatation. If either exist, resection or direct ductal drainage will be required.