Emergency surgery for pancreatic pseudocysts.

Pancreatic pseudocysts are a frequent complication of acute and chronic pancreatitis. The management of acute surgical emergencies associated with pseudocysts is unique. In a series of 117 patients with one or more pancreatic pseudocysts, 32% required urgent operation because of a cyst-related complication. The mean day of pseudocyst diagnosis was 7.8. Thirty percent of the patients had operation on the day of admission, while 70% required operation during cyst maturation because of an increase in size of the cyst or suspected rupture or infection. Twelve patients were found to have mature cysts at operation and had internal drainage, and external drainage was used in 56%. A pancreatic fistula developed in 22% of the patients, and septic complications occurred in 27% of surviving patients. The overall mortality was 18.9%. Mortality was 18% and 19%, respectively, for patients who had operation on the day of admission or during cyst maturation.