Pancreatic pseudocysts.

Pseudocysts are fascinating lesions of the pancreas which present as upper abdominal masses in about 80 per cent of cases, but also as obstructive jaundice, intrasplenic and intra-left-renal masses, mediastinal masses, flank abscess, pleural effusions, and ascites rich in amylase. They are diagnosed by urine amylase with greater sensitivity than by serum amylase. Cysts must be differentiated from pancreatic abscesses, indolent phlegmonous pancreatitis, cystadenomas, and carcinomas of the pancreas, as well as lymphomas and other rare tumors. They may be satisfactorily treated by large sump tube drains to the outside but about one third will require a further operation. Internal drainage by cystogastrostomy is the simplest and best current procedure, but not applicable to all cases. A good alternative is Roux-en-y cyst-jejunostomy. Caution is needed in the preoperative workup since all procedures are accompanied by an operative mortality approaching 10 per cent, mostly due to hepatic disease, portal hypertension, stress ulcerations, and hemorrhage. The follow-up shows 85 per cent good results from proper drainage but 40 per cent are diabetics and in many patients the ravages of alcoholism continue unabated.