Surgical management of complicated pancreatic pseudocysts after acute pancreatitis

Management of pancreatic pseudocysts (PP) is unclear when located in areas outside the lesser sac, infected, or when portal venous (PV) occlusion is present.

Patients having internal drainage of PP. Management and outcome were assessed relative to location, presence of infection, and/or PV occlusion.

No patient required transfusion, and there were no readmissions in 9 patients with PV occlusion. Eleven patients had infected PP including 5 extending outside the lesser sac. Six had postoperative imaging, 4 readmission, and 3 required adjunct postoperative percutaneous drainage. All but 2 with PP beyond the lesser sac had Roux-en-Y cystjejunostomy including 4 with 2 anastomoses. Nine, 4, and 5 required reimaging, readmission, and postoperative therapeutic intervention, respectively.

(1) Open PP drainage in the face of PV occlusion confers a low risk of bleeding and a minimal need for reimaging or readmission; (2) internal drainage of infected PP is a viable option to external drainage; and (3) PP extending beyond the lesser sac can most often be managed successfully by Roux-en-Y drainage but may require additional intervention.