Pancreatic cyst

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Classification according to ICD-10
K86.2 Pancreatic cyst
K86.3 Pseudocyst of the pancreas
ICD-10 online (WHO version 2019)

As pancreatic cyst (or Bauchspeicheldrüsenzsyste ) a pathological bubble-like formation (referred to cyst ) in the pancreas ( pancreas ). They are divided into real cysts and pseudocysts.

Classification and causes

Pancreatic cysts can be mechanical, inflammatory, or neoplastic in nature. If the ontogenesis develops incorrectly , cysts can also occur in the pancreas.

Real cysts

These are cysts lined with epithelium . The cyst contents do not contain any of the pancreatic enzymes such as lipase or amylase . Overall, the real cysts are rare. The real cysts can be classified as follows:

  • Congenital cysts: The congenital cysts can occasionally be associated with cyst kidneys and cyst livers.
  • Retention cysts: They arise from the narrowing and subsequent swelling of a pancreatic duct. The retention cysts often occur in the context of chronic pancreatitis . The cysts lined with duct epithelium are small, multiple and are in contact with the major pancreatic duct .
  • neoplastic cysts: These are mostly cyst adenomas or cyst adenocarcinomas . They can take the form of a single-chambered cyst, which can not be distinguished from the pseudocyst by imaging techniques (e.g. sonography ). The walls of these cysts are made up of tumor epithelium.

Pseudocysts of the pancreas

These most common cysts usually arise from an injury ( trauma ) to the pancreas, acute pancreatitis or chronic recurrent pancreatitis. In contrast to the real cysts, the border of these cysts consists of scarred connective tissue . The pancreatic enzymes cause self-digestion of the pancreatic tissue, whereby the connection to the duct system can be maintained. Pseudocysts contain either serous or bloody (hemorrhagic) fluid, and necrotic tissue residues may also be present.

Symptoms

Depending on the size, it can lead to upper abdominal pain radiating to the back and colic . A tumor in the upper abdomen may be palpable. Often, pancreatic cysts remain asymptomatic.

diagnosis

Pancreatic cysts can be visualized well using sonography; computed tomography , ERCP or angiography may be indicated. In the case of injuries to the pancreas, lavage of the abdomen may be indicated in order to determine the amylase and lipase.

therapy

Cysts caused by pancreatitis can regress spontaneously, so they are observed first. If the size of the cyst causes discomfort, it can be drained. With a duodenoscope or a combined endosonography gastroscope, a hole is cut through the stomach or duodenum in the stomach or intestinal wall to the pancreatic cyst and then a plastic tube (stent) is inserted into this hole. The cyst fluid can drain through this stent. After about 3 months, the cysts are usually empty and the cyst walls are stuck together. The stent can now be removed. If there is pus in the cyst, the hole is expanded using an inflatable catheter until an endoscope can be inserted through the hole into the cyst. The endoscope can now be used to remove scabs and necrotic material . Due to the endoscopic approach, surgical relief operations are generally not required.

Complications

Bleeding, abscesses and the formation of ascites can occur. The duodenum can also be relocated. If the bile duct is obstructed, jaundice is possible.

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