Pancreatic pseudocyst. Changing concepts in management.

One hundred seven patients with pseudocyst managed during the past decade were reviewed. The mortality rate of 11.2 percent compares favorably with the rates in other recent series. Twenty-two percent of the patients were managed conservatively, and 76 underwent exploration. None of the nonoperative patients died from complications of the cyst. In all five patients (4.8 percent) who died, the cause was sepsis and multiorgan failure unrelated to the cyst. Patients with external drainage had a 90 percent complication rate. In addition, in four of five patients attempts at treatment by needle aspiration failed. Internal drainage of all types was complicated in 50 percent of patients, with a surprising absence of complications associated with cystojejunostomy. Asymptomatic pseudocysts may be safely treated conservatively with a good expectation of spontaneous resolution. Eight patients had pseudocysts secondary to biliary tract disease alone. Perhaps the incidence of this complication would have been lower if the biliary disease had been treated. This would support the argument for early surgical intervention in patients with acute pancreatitis secondary to biliary stones.