Pancreatic Cyst - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Pancreatic cyst

Content:

• Pancreatic cyst classification
• Causes and predisposing factors
• Pancreatic cyst symptoms
• Diagnostics of the pancreatic cyst
• Complications with large cysts
• Conservative treatment of cysts
• Surgical treatments for cysts

Any large formation that appears in the cavity of the internal organs necessarily causes their functional impairment. The same rule applies to pancreatic cysts. A cyst is a cavity formation surrounded by walls of connective tissue.

The larger the cyst becomes, the more the pancreas suffers. As a result, its tissue is destroyed, the secretory function decreases, as a result - the body suffers from a lack of vital hormones and enzymes. So that the quality of human life is not violated, it is necessary to identify and eliminate this pathology.

Pancreatic cyst classification

All cysts that form on the pancreas can be classified according to two main criteria - by their structure and by the place of localization on the organ. These signs are recommended for consideration in clinical guidelines for surgery.

So, according to their structure, cysts are divided into:

• False formations, that is, those that began to form after any disease. These cysts do not have a glandular epithelial layer in the structure of their walls.
• True formations, that is, those that began to form during intrauterine development. These cysts have an epithelial layer, but they are very rare.

By the place of localization of education on the organ, one can distinguish:

• On the body of the organ. These cysts are more common than others. When they are formed, the position of the stomach and colon is disrupted. The prevalence is 47.
• On the tail of the organ. Caudal cysts are less common than neck cysts. During the formation of this cyst, the organs surrounding the pancreas are not affected. The prevalence is 38.2.
• On the head of the organ, located in the cavity of the omental bursa. This is the rarest localization of education. In this case, clamping of the duodenum can occur. The prevalence rate is 16.8 (according to Professor G. D. Vilyavin).

Due to the fact that a true cyst is an extremely rare phenomenon, and its symptoms and treatment tactics are not much different from the signs and therapeutic scheme for false cysts, it is with respect to the latter formations that we will be discussed in the future.

Causes and predisposing factors

A person's age is not a risk factor for cyst formation. They can have various shapes and sizes, and with its congenital origin, systemic polycystic disease is often found. That is, there are formations in the brain, on the ovaries, in the liver and kidneys.

A false cyst develops only on a diseased organ. A healthy pancreas cannot suffer from it, since it is the result of some disease.

Anatoly Alekseevich Kurygin pointed out that the most common reasons leading to the development of a cyst are:

• 84.3% of cysts are formed during exacerbation of pancreatitis;
• 14% of cysts develop against the background of an organ injury;
• Blocking the outflow duct, as well as a significant deterioration in its motility, can cause the formation of cysts;
• Infection with helminths, namely with chronic biohelminthiasis (cysticercosis or echinococcosis);
• Organ tumors.

In addition, in percentage terms, several factors have been identified and proven that lead to the formation of a pancreatic cyst (according to the Russian surgical community):

• 62.3% - frequent consumption of strong alcoholic beverages;
• 32.1% - lipid metabolism disorders leading to obesity (diagnostic criterion - increased cholesterol and beta lipid fractions);
• 15.3% - diabetes mellitus, most often of the second type;
• 14% - existing cholelithiasis;
• Previous surgery on the gastrointestinal tract (optional on the pancreas).

If the patient has clinical signs of pancreatic lesions against the background of one or more risk factors, then it makes sense to suspect a cystic formation.

Pancreatic cyst symptoms

The fact that the patient has a cyst can be suspected by the following characteristic signs:

• An attack of acute pancreatitis, which is expressed in pain of a shingles nature (in the epigastric region, they occur less often). An increase in painful sensations occurs after drinking alcohol or after eating. At the same time, NSAIDs and antispasmodics are not able to relieve pain. In parallel, the patient suffers from vomiting, diarrhea, flatulence and bloating. The stool becomes greasy as lipase secretion is impaired.
• After a month or 5 weeks, the symptoms of acute pancreatitis disappear. This is the so-called "bright period".
• Recurrence of the disease. Moreover, each next attack is more and more pronounced and prolonged.

In parallel, the patient may complain about:

• An increase in body temperature to subfebrile levels;
• The appearance of gravity in the area of the left hypochondrium;
• The appearance of general weakness;
• Formation of jaundice with staining of the mucous membranes and sclera (observed in 6% of cases).

A cyst can cause a disruption in hormonal secretion (glucagon, insulin, somatostatin), which is expressed:

• In constant thirst from dry mouth;
• In a loss from consciousness due to the development of a coma of a hyper or hypoglycemic type;
• With an increase in urination, the patient can excrete up to 15 liters of urine per day.

The doctor, on the basis of visual and palpation examination, may suspect a cyst, since a protrusion of the abdominal wall can be found in the area under the sternum. However, this symptom is typical for the cyst, which is located on the head of the organ, and its volume reaches 200 ml. Nevertheless, according to Kurygin, this symptom can be found in 56% of patients.

Diagnostics of the pancreatic cyst

Ultrasound is the standard method of examining the pancreas, including for detecting cysts. If the patient has a cyst, then on the screen the diagnostician will see an object that has a rounded shape, which has a reduced echogenicity, that is, it will look like a light spot against the background of a dark organ. The flat outline constraint is most often a cystic wall. If there are no formations on the organ, then the pancreas is visualized as a dark (echogenic) spot with a bumpy surface. There will be no bumps on the meta of localization of education, since they are smoothed out.

If for some reason an ultrasound scan cannot be performed, then the patient can be sent for CT or MRI. X-ray examination of information about the cyst will not give.

As for laboratory tests, a cyst may be indirectly indicated by a prolonged increase in amylase in the blood, which can be determined based on a biochemical blood test.

Complications with large cysts

If education is not diagnosed and treated for a long period of time, then this can threaten with such consequences as:

• Suppuration of an organ, or the development of an abscess;
• The development of bleeding due to a violation of the integrity of the vessels;
• Break;
• Fistula formation.

Conservative treatment of pancreatic cysts

You can get rid of education without surgery under the following conditions:

• The overgrowth volume does not exceed 20 mm.
• The cyst is single.
• Education has clear limitations.
• There is no obstructive jaundice.
• The patient does not suffer from severe pain.

The first 3 days, the patient must adhere to a hungry diet. Further, the diet should be as gentle as possible. It excludes everything salty and fatty, as well as fried. Thus, it will be possible to reduce the enzymatic secretion of the organ, which stimulates the destruction of the gland tissues. Bed rest must be adhered to for a week (up to 10 days). During this time, smoking and drinking are prohibited.

To exclude the possibility of cyst suppuration and the penetration of a bacterial infection into the peritoneal cavity, the patient is prescribed a course of antibiotics. If this is not done, then the bacterial process that has begun can spread not only to the gland, but also to nearby organs. With a cyst, drugs from a number of cephalosporins and tetracyclines are prescribed.

So that the patient does not suffer from severe pain, he may be advised to take drugs - proton pump inhibitors. Among those are Rabeprazole, Omeprazole, Omez, etc.

Enzymatic therapy is performed using drugs such as Pancreatin and Creon. It is designed to improve the digestion of carbohydrates and fats. It is important that the preparations do not contain bile acids, but that there are enzymes - amylase and lipase.

When, after a month's therapeutic course, the desired effect cannot be achieved, an operation is necessary.

On the subject: The most effective recipes for restoring the pancreas!

Surgical treatments for pancreatic cysts

Modern medicine involves removing the cyst using minimally invasive techniques. Nevertheless, 92% of patients are forced to stay in a hospital during treatment. There are about seven options for the operation.

If the intervention is carried out under the control of an ultrasound machine, then this significantly reduces the risk of developing possible complications. They are shown when the formation is located in the region of the body of the organ or in the region of its head, since it is in these cases that they give the best effect. To perform the procedure, the patient is punctured in the epigastric region, a puncture needle is inserted through it (as an option, an aspirator), after which the cyst is removed.

The surgeon's manipulations depend on the size of the formation:

• Sclerotherapy of education is based on the introduction of a solution with a certain chemical activity. It is injected after the cyst has been emptied. In the future, a natural process of proliferation of connective tissue occurs and the defect is eliminated.
• Puncture drainage of the cyst is based on its removal and the establishment of drainage, which contributes to the constant outflow of fluid. Until the discharge stops, the patient will need to walk with the tube, otherwise the connective tissue will not grow. A contraindication to the operation is the size of the cyst more than 100 ml (in some cases, more than 50 ml), as well as overlapping by the formation of the duct of the gland.

If it is not possible to perform the procedure through the skin, then laparoscopic techniques are used. To do this, the surgeon makes two incisions, equipment is inserted through them, and the cyst is removed.

However, even despite the fact that this procedure belongs to minimally invasive interventions, the risk of complications remains high:

• Laparoscopic resection, which is performed in the presence of a pronounced defect in the tissues of the organ. For example, if the cyst of the head of the gland is 50-70 mm in size, then removal of the head is required. Although this operation is quite traumatic, the risk of recurrence is minimal.
• Excision and occlusion of education. It is possible to perform this operation when the cyst is located superficially. During the procedure, the surgeon opens it, sanitizes it using antiseptic solutions and sutures it tightly. It is possible to use an electrocoagulator instead of a needle, but in this case it will be necessary to install a drainage tube for up to a week.
• Frey's operation, which involves resection of the head and the creation of a pancreato-jejunal anastomosis. This operation is one of the options for laparoscopic resection. It is performed in the case when the organ duct has a pronounced expansion. In this case, the expanded duct is sewn into the wall of the small intestine. Such manipulations normalize enzymatic activity and minimize the risk of pancreatic necrosis.

Laparotomy surgery is the most recent option for surgeons. To perform it, an opening of the abdominal cavity is necessary. In this case, the patient will have to go through a long recovery period.

Laparotomy can be performed according to the principle:

• Open resection;
• On the principle of excision of education and its further drainage;
• According to the principle of cyst marsupialization. In this case, the formation is opened, sanitized, and its walls are suspended along the edges of the cut. At the end of the process, the wound is sutured in layers. As a result, the pathological focus is closed. The most pronounced disadvantage is the formation of fistulas.

Pancreatic cyst is a rare pathology and occurs in no more than 0, 006% of the population in the world (according to Professor V. V. Vinogradov). Nevertheless, it significantly reduces the patient's quality of life, which is why its timely detection and removal is so important. Therapy of education at the present stage of development of medicine is not difficult, therefore, patients need to seek qualified help, and not self-medicate.

The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist

Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).