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Pancreatic cysts
Last reviewed: 23.04.2024
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The pancreas cyst is a very common pathology. The cyst is the formation of separate cavities (capsules) in the tissues (parenchyma) or outside the gland with liquid contents. It includes the digestive secret of the pancreas, as well as decayed necrotic tissue (tissue detritus).
Depending on the etiology of the pancreas cyst is true (congenital) and false (acquired). At the location of the cavity in the body are different: the cyst of the head of the pancreas, the cyst of the body of the pancreas and the cyst of the tail of the pancreas.
[Causes of pancreatic cyst
The true cyst of the pancreas (or dysentogenetic cyst) is the result
Inborn violations of the development of this body. Inside, the true cyst is lined with epithelium. This disease is rarely diagnosed, since the size of the true pancreas cyst is usually minor. Therefore, it does not put pressure on surrounding tissues and organs and does not cause any complaints. As practice shows, such a cyst is discovered quite by accident - during ultrasound, which a person goes through about any other disease.
However, if the true cyst of the pancreas is formed due to congenital obstruction of the gland ducts and accumulation of secreted secretions in them, chronic inflammation develops with the formation of fibrous tissue - cystic fibrosis of the pancreas or cystic fibrosis.
The false cyst of the pancreas (pseudocyst) is lined inside not with epithelium, but with fibrous and granulation tissue. Among the causes that cause the formation of false cysts include pancreatic injury, inflammatory diseases (pancreatitis, chronic pancreatitis, pancreonecrosis), as well as pancreatitis, in which the stones formed in the gland can block the ducts, which gives impetus to the development of the so-called retention cyst .
According to medical statistics, 90% of cases of false pancreatic cysts are a consequence of acute pancreatitis, and 10% of cysts appear as a result of pancreatic injury. Of these, up to 85% is the cyst of the body of the pancreas or the cyst of the tail of the pancreas, 15% is the cyst of the head of the pancreas.
It should be noted that with excessive consumption of fatty and fried foods and alcohol abuse, the risk of pancreatic cyst formation increases. Thus, 60-70% of patients with primary chronic alcoholic pancreatitis develop a false pancreatic cyst.
Symptoms of the pancreas cyst
A characteristic symptom of pancreatic cysts is permanent or paroxysmal pain in the epigastric region (that is, at the site of the projection of the stomach on the anterior abdominal wall) and in the right or left hypochondrium.
Often the pain is felt in the navel. In this case, pain can be given in the back (since the pancreas is located on the posterior abdominal wall), as well as in the left arm and shoulder. In many cases, pain sensations cease to be local and acquire a shingling character, and their strength increases manyfold. In this case, the most severe pains occur when the cyst of the pancreas presses on the celiac and solar plexus.
When probing, another symptom of the pancreas cyst is revealed - painful volume formation in the epigastric region or on the left under the ribs. If the cyst reaches a significant size, patients themselves see in the upper abdomen a pathological "bulging". In addition, patients complain of a feeling of heaviness in the stomach, belching, and heartburn.
The enlarged cyst of the pancreas begins to press on neighboring organs, disrupting their normal functioning. For example, the cyst of the head of the pancreas can squeeze the bile duct, resulting in stenosis of the duodenum, nausea, vomiting, mechanical jaundice. A squeezing of the main duct of the pancreas leads to dyspepsia (digestive disorders), diarrhea (frequent fluid stools) and very severe pain. In this case, acute pancreatitis is diagnosed.
Concomitant infection, which leads to the formation of purulent masses inside the cyst, causes fever, chills and general weakness. In fact, it is abscess (abscess) cysts. In this disease, perforation of the pancreas cyst occurs: the cavity is torn, causing bleeding (perforation of the cyst), and its purulent contents enter directly into the abdominal cavity. Symptoms of this condition are severe pain, cold sweat and loss of consciousness. This can lead to inflammation of the abdominal cavity - peritonitis, which threatens life and requires emergency medical care. According to clinical practice, the rupture of the pancreatic cyst, which is accompanied by bleeding, in more than 60% of cases leads to a fatal outcome.
Where does it hurt?
Diagnosis of the pancreatic cyst
The main method used to diagnose the pancreas cyst is ultrasound (ultrasound). During the examination of the abdominal cavity, the gastroenterologist assesses the condition of the pancreas and surrounding organs, determines the presence of the pathological cavity and determines its localization, shape and size.
In order to differentiate pancreatic cysts from chronic pancreatitis, malignant tumors of the gland itself and neighboring organs, aneurysms of the abdominal aorta, ovarian cysts, etc. Resort to magnetic resonance imaging (MRI).
If it is necessary to biochemical, cytological and microbiological examination of the contents of the pancreatic cyst through the anterior abdominal wall, it is punctured by monitoring the diagnostic procedure with ultrasound or CT.
A laboratory study of blood counts (for hemoglobin and hematocrit) is performed, which is necessary to determine the presence of latent bleeding in the cavity of the false cyst.
Cysts of the pancreas - Diagnosis
What do need to examine?
Treatment of pancreatic cyst
The tactics of treating the pancreatic cyst are determined by such indicators as
Stage of its development, peculiarities of communication with the duct of the pancreas and, of course, the presence and nature of complicating factors.
If the cyst does not exceed 3-5 cm and the disease proceeds without complications, according to the indications, anesthetics and a diet with restriction of fats and proteins are prescribed. Observation of the patient's condition lasts about 1.5 months. If the cyst does not increase, the patient is prescribed a diet and systematic (1-2 times a year) ultrasound - to monitor the dynamics of the pathological process.
It should be borne in mind that a false pancreas cyst 6 cm in diameter and more rarely is cured without the help of surgeons and, moreover, has a clear tendency to increase and appear various complications: rupture, bleeding, pancreatic abscess.
Nevertheless, the clinical practice of recent years shows that a false cyst of the pancreas in acute pancreatitis in a third of patients spontaneously resolves in 3-4 months after the attack. But the cyst in the chronic course of inflammation of the pancreas, indeed, disappears by itself ...
Surgical treatment of the pancreas cyst, in the first place, implies the removal of contents from its cavity (drainage). To this end, laparoscopic drainage is widely used - a modern, minimally invasive technique in which the abdominal cavity is intervened through small openings. Such a drainage of the pancreatic cyst gives minimal complications, but it is possible only in the absence of suppuration.
If there is inflammation of the cyst with the release of pus or there are all signs of compression of the common bile duct, the patient is laparotomically (hollow) cyst dissection and her endoscopic transpapillary, transdermal or overdrainage drainage.
In cases where the cyst completely blocks the outflowing pancreatic duct, a cystoenterostomy surgery is performed: first the cystic cavity is opened and released from the contents, then treated with appropriate preparations, and finally an anastomosis (connection) with the small intestine is formed.
In some cases - when the cyst is small, mobile and has well-formed walls - the pancreatic cyst is removed (extirpation). A very complicated operation for the radical removal of a cyst is a resection of a part of the pancreas. But this kind of surgical treatment of the pancreas cyst often does not give the expected effect, and it is used only when the cyst undergoes a malignant degeneration.
Prevention of pancreatic cyst
As with other pathologies of the digestive system and gastrointestinal tract, the quality and diet regimen play an important role in the prevention of pancreatic cysts.
Diet in the pancreas cyst involves the exclusion from the diet of food, which contains a large amount of fats and carbohydrates, all fried, fatty and spicy. Start eating healthy foods, especially fresh vegetables and fruits. And you should eat more often, but in small portions.
Inflammatory processes in the stomach and duodenum should be cured, as well as getting rid of stones in the gallbladder. Nutritionists recommend eating more grapes, which contributes to the normalization of pancreatic functions.
The pancreas is also harmed: thoughtless intake of medicines for self-medication, smoking, alcohol, sedentary lifestyle and stress.
With the diagnosis of the pancreas cyst, the forecast is not very comforting. Passage is very problematic, as the cyst is prone to inflammation. And the inflammatory process in a closed cavity is able to take such a scale that only an urgent operation can save a life.