Management of pancreatic pseudocysts in 42 patients with inflammatory or traumatic cysts.

In attempts to determine and appropriate treatment for pancreatic pseudocysts, forty-two cases were reviewed. Twenty-three were inflammatory and nineteen were traumatic. Elevation of serum amylase levels and white blood cell count occurred more frequently in patients with traumatic cysts than in those with inflammatory ones. Filling of the pseudocysts occurred in eleven of twelve patients in whom endoscopic retrograde pancreatography (ERP) had been performed. Spontaneous regression of the cysts occurred more frequently in those with traumatic cysts (42 per cent) than in those with inflammatory cysts (26 per cent). Excision of the cysts were performed in seven of twenty-three patients with inflammatory cysts; external drainage in five with inflammatory cysts and in one with traumatic cysts; and internal drainage in five with inflammatory cysts and ten with traumatic cysts. There was a recurrence of the cysts in two patients, one due to multiple stenosis of the pancreatic duct located to the right of the resected cysts, and the other was caused by an anastomotic stenosis of the cystogastrostomy. One persistent pancreatic fistula following external drainage was treated by fistulogastrostomy. We recommend the evaluation of the condition of pancreatic duct by ERP for individualizing pancreatic pseudocysts.