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ORIGINAL PAPERS 359Jurnalul de Chirurgie (Iaşi), 2012, Vol. 8, Nr. 4PANCREATIC PSEUDOCYST– ACTUAL THERAPEUTIC OPTIONS –S. Săndulescu , V. Şurlin, I. Busuioc, D. Cartu, E. Georgescu, I. GeorgescuDepartament of Surgery, University of Medicine and Pharmacy CraiovaFirst Surgical Clinic, Emergency County Hospital CraiovaPANCREATIC PSEUDOCYST – ACTUAL THERAPEUTIC OPTIONS (Abstract):BACKGROUND: Pancreatic pseudocyst (PP) is one of the most frequent complications of acuteand chronic pancreatitis; patients with these disorders often benefit from interventional treatment,or minimally invasive surgery. Progress of new minimally invasive interventional techniques(endoscopic internal drainage, external drainage guided by ultrasound / CT / laparoscopic surgery)for the treatment of pancreatic pseudocyst formed the basis for the arguments of this article.AIM: The purpose of this article is to analyze and highlight the above views on a series ofconsecutive cases of pancreatic pseudocyst. MATERIAL AND METHOD: We studied 46patients diagnosed with pancreatic pseudocyst in a period of 6 years, from 2006 to 2011.RESULTS: 26 patients (56.52%) were treated conservatively and followed periodically byimaging (ultrasound, CT); 20 patients (43.47%) required ther apeutic attitude because ofsymptomatic PP or lack of tendency to resorption (increase in size at successive examinations). 2patients (4.34%) were drained externally under ultrasound/CT guidance. 10 patients (21.7%) weresubmitted to endoscopic drainage as follows: 2 transpapillary drainage, 5 transgastric and 3transduodenal drainage, respectively. Surgical interventions were performed in 8 patients(17.39%), 4 cysto-gastrostomy, 3 cysto-jejunostomy and 3 external drainages (2 patients with duallocalization of PP). We noted a postoperative complication after cysto-jejunostomy: uppergastrointestinal bleeding at 6th postoperative day from splenic artery hemorrhage, inside the PP. Itwas diagnosed by angiography and re-operation was required for hemostasis. Data from theliterature concerning the therapeutic protocol in pancreatic pseudocyst ere reviewed.CONCLUSION: The PP management depends on PP site, size and “matureness” and isindividualized for each case. Different treatment options are available: external drainage under CT/ ultrasound guidance, endoscopic drainage, surgical procedures. To minimize the postoperativemorbidity rate, surgical internal drainage is addressed to PP mature over 6 weeks from the lastepisode of acute pancreatitis.KEY WORDS: PANCREATIC PSEUDOCYST; PANCREATITISSHORT TITLE: Pancreatic pseudocystHOW TO CITE: Săndulescu S, Şurlin V, Busuioc I, Cartu D, Georgescu E, Georgescu I. [Pancreatic pseudocyst – actualtherapeutic options] Jurnalul de chirurgie (Iaşi). 2012; 8(4): 359-364.INTRODUCTIONPancreatic pseudocyst (PP) is a fluidcollection intra or peripancreatic withoutepithelial coating containing pancreatic juicerich in proteolytic emzimes without clinicalsigns of infection. It is bordered by thescleroinflamatory tissue from surroundinganatomical structures, the wall being formedof a fibrous and granulation tissue derivedfrom parietal and visceral peritoneum.Pancreatic pseudocyst is one of themost frequent complications of acute andchronic pancreatitis, patients with thesedisorders often benefit from interventionaltreatment, or minimally invasive surgery.Diagnosis of pancreatic pseudocyst hasReceived date: 18.10.2012Accepted date: 08.11.2012Correspondence to: Sarmis Săndulescu, MDFirst Surgical Unit, Emergency County Hospital CraiovaClinica I Chirurgie CraiovaStr. Tabaci No. 1 Craiova, RomaniaPhone / Fax: 0040 (0) 251 50 22 85E-mail: ssarmis@yahoo.com