Erosion of adjacent organs by pancreatic pseudocysts

Erosion of adjacent organs occurred in 19 of 80 patients with pseudocysts of the pancreas (22%). A total of 26 organs were eroded. Thirteen patients had single organ erosion and six patients had two or more sites of involvement. The gastrointestinal tract was most frequently affected (stomach-seven, duodenum-five, duodenojejunal junction-two, colon-two). It is probable that many of these communications occur without detection and result in spontaneous internal drainage of the cyst. The surgical management of cystenteric fistulas is attended by a low morbidity and mortality. Urinary tract involvement occurred in two patients, both of whom recovered following correction of the communication and retrograde drainage of the pancreatic ducts. Eight patients developed erosion of adjacent major arteries and in six this resulted in major upper gastrointestinal hemorrhage. Two of these patients died as a direct consequence of the vascular erosion. Vascular involvement clearly represents a formidable complication in patients with pancreatic pseudocyst. This study illustrates the diverse complications that may develop when pseudocysts erode into adjacent organs. The risks appear to be greatest in cysts that develop in the course of chronic pancreatitis, in acute cysts associated with severe necrotizing pancreatitis, and when acute cysts are followed for prolonged intervals without surgical decompression.