Pancreatic pseudocyst.pptx

pancreatic pseudocysts : definition and classification.

1. Pancreatic pseudocyst definitions and classifications Dr Karrar Adil

2. Definitions : is a collection of amylase-rich fluid enclosed in a well-defined wall of fibrous or granulation tissue. It typically arises following an attack of acute pancreatitis, but can develop in chronic pancreatitis or after pancreatic trauma . Formation of a pseudocyst requires 4 weeks or more from the onset of acute pancreatitis. It is often single, but may be multiple and more than half will be found to have a communication with the main pancreatic duct.

3. Today, the most used definitions differentiate between peripancreatic fluid collections, pseudocysts and pancreatic abscesses are in the Atlanta classification system for acute pancreatitis : Acute Fluid Collections: occur early in the course of acute pancreatitis, are located in or near the pancreas, and always lack a wall of granulation or fibrous tissue. Pancreatic Abscess: is a circumscribed intraabdominal collection of pus, usually in proximity with the pancreas, containing little or no pancreatic necrosis, arising as the consequence of acute pancreatitis, trauma or chronic pancreatitis.

4. Acute Pseudocysts : are constituted by pancreatic juice enclosed by a wall of fibrous or granulation tissue, arising as a consequence of acute pancreatitis or pancreatic trauma. Chronic Pseudocysts : are constituted by pancreatic juice enclosed by a wall of fibrous or granulation tissue, arising as a consequence of chronic pancreatitis and lacking an antecedent episode of acute pancreatitis.

5. Contrast enhanced CT image, obtained at admission, reveals acute peripancreatic fluid collection (F) Contrast enhanced CT image, obtained 6 weeks after the onset of acute attack, reveals a pseudocyst (Ps).

6. Classifications Sarles classification D’Egidio classification Nealon and Walser classification

7. Sarles classification of pancreatic pseudocyst : An early proposed classification of pancreatic pseudocysts depended on the association with acute or chronic pancreatitis . Necrotic pseudocyst in acute pancreatitis. Retention cyst in chronic pancreatitis. lntrapancreatic retention due to pancreatic duct dilatation. Extrapancreatic retention cyst due to rupture into peripancreatic tissues .

8. The D’EGIDIO Classification of Pancreatic Pseudocyst : proposed by D’Egidio and Schein in 1991. based on the underlying etiology of pancreatitis (acute or chronic), the pancreatic ductal anatomy, and the presence of communication between the cyst and the pancreatic duct. identified three distinct types of pseudocysts :

9. Type I : After an attack of acute pancreatitis. Normal duct anatomy; duct-cyst communication : no fistula/communication. Type lI : After an attack of acute on chronic pancreatitis. Abnormal duct anatomy without stricture; duct-cyst communication : 50 % chances of fistula. Type Ill : After an attack of chronic pancreatitis, abnormal anatomy with stricture; duct-cyst communication : always communicating.

10. Nealon and Walser ERCP classification : This classification system based solely on pancreatic duct anatomy. on the postulate that the main pancreatic duct determines the type and course of the pseudocysts . Published in 2002, so far, this classification had limited use.

11. Type I : normal duct / no communication with cyst. Type II : normal duct with duct-cyst communication. Type III : otherwise normal duct with stricture and no duct-cyst communication. Type IV : otherwise normal duct with stricture and duct-cyst communication. Type V : otherwise normal duct with complete obstruction. Type VI : chronic pancreatitis, no duct-cyst communication. Type VII : chronic pancreatitis with duct-cyst communication.

12. Type I Type II Type III Type IV Type V Type VI Type VII

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