Beyond the Six-Week Rule: Contemporary Insights Into Pancreatic Pseudocyst

Pancreatic pseudocysts are a frequent consequence of pancreatic injury and represent a heterogeneous group of fluid collections with variable clinical behavior. While some resolve spontaneously, others may lead to complications such as infection, hemorrhage, or obstruction, often after a prolonged and uncertain clinical course. Advances in cross-sectional imaging and endoscopic ultrasound have improved the ability to distinguish pseudocysts from other pancreatic fluid collections and cystic lesions, enabling more accurate diagnosis and safer intervention. At the same time, minimally invasive endoscopic and image-guided techniques have significantly reduced the need for surgical management in appropriately selected patients. This review provides a practical clinical overview of pancreatic pseudocysts, focusing on pathophysiology, diagnostic challenges, and treatment strategies. Emphasis is placed on a stepwise, individualized approach in which conservative management, endoscopic drainage, percutaneous techniques, and surgery each have defined roles. Effective management depends on clinical presentation, complications, ductal anatomy, and the timing of intervention rather than cyst size or duration alone. A multidisciplinary, patient-centered strategy remains essential for achieving optimal outcomes while minimizing unnecessary intervention.