Giant Pancreatic Pseudocyst an Uncommon Diagnosis in the Gambia. Experience with Two Cases over a Year

Abstract Pancreatic pseudocysts are a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. Currently several classification systems are in use that are based on the origin of the pseudocyst, their relation to pancreatic duct anatomy and a possible pseudocyst–duct communication. Diagnosis is accomplished most often by CT scanning, by endoscopic retrograde cholangiopancreatography (ERCP) or by ultrasound, and rapid progress in the improvement of diagnostic tools has enabled detection with high sensitivity and specificity. There are different therapeutic strategies: endoscopic transpapillary or transmural drainage, percutaneous catheter drainage, or open surgery. The feasibility of endoscopic drainage is highly dependent on the anatomy and topography of the pseudocyst but provides high success and low complication rates. Percutaneous drainage is used for infected pseudocysts. However, its usefulness in chronic pancreatitis-associated pseudocysts is questionable. Internal drainage and pseudocyst resection are frequently used as surgical approaches with a good overall outcome, but a somewhat higher morbidity and mortality compared with endoscopic intervention. We therefore conclude that pseudocyst treatment in chronic pancreatitis can be effectively achieved by both endoscopic and surgical means. The prevalence of pancreatic pseudocysts in acute pancreatitis has been reported to range from 6% to 18.5%. The prevalence of pancreatic pseudocysts in chronic pancreatitis ranges 20% to 40%. The incidence of pseudocysts is low ranging from 1.6 to 4.5% or 0.5 to 1 per 100000 adults per year. The authors report their personal experience with pancreatic pseudocysts that they encountered over 1 year of surgical practice in one of the busiest hospitals in the Gambia and discuss various management options. There are no randomized studies for the management protocols for pancreatic pseudocysts. Therefore, today we must rely on best clinical practice, but still certain advice may be given. First, it is important to differentiate acute from chronic pseudocysts for management, but at the same time does not miss cystic neoplasia’s. Conservative treatment should always be considered the first option (pseudocysts should not be treated just because they are there). However, if intervention is needed, a procedure that is well known should always be considered first. The results of percutaneous or endoscopic drainage are probably more dependent on the experience of the interventionist than the choice of procedure and if surgery is needed, an intern anastomosis can hold sutures not until several weeks (if possible 6 weeks). Keywords: pancreas; pancreatic pseudocyst; acute pancreatitis; chronic pancreatitis; pancreatic fluid collection; pancreatic local complication.