[Pseudocysts of the pancreas. Diagnosis, course and principles of treatment]

Pseudocysts of the pancreas are collections of liquid more or less completely composed of pancreatic secretions. Patients with acute pancreatitis without underlying chronic pancreatitis may develop necrotic pseudocysts while those with chronic pancreatitis may develop either necrotic or retention pseudocysts. The prevalence and localization are largely dictated by the cause of the pancreatitis. Ultrasonography and computed tomography give the diagnosis and reveal the size, localization and relations of the pseudocyst. Some pseudocysts may regress spontaneously, usually within a few weeks, especially necrotic pseudocysts measuring less than 6 cm. In others, complications include acute infection, intracystic bleeding, rupture, fistulization and compression of neighboring organs. Surgery was classically proposed for all pseudocysts, but puncture-evacuation and percutaneous or endoscopic drainage have also been successful. The risk of recurrence is higher with puncture-evacuation. Today, complicated forms and unsuccessful medical treatment are good indications for surgery. Cystodigestive drainage is preferred although exeresis may be required in specific cases.