Walled-Off Pancreatic Fluid Collections

Abstract

Walled-off pancreatic fluid collections are made up of pseudocysts (PC) and walled-off pancreatic necrosis (WOPN). Pseudocysts contain only liquid, whereas WOPN consists of liquid and solid components that have undergone necrosis. Patients will usually present with abdominal pain, fever, gastric outlet obstruction, pseudoaneurysm, fistulas, pancreatic ascites, or pleural effusions. Diagnosis can be made by previous history of pancreatitis or pancreatic trauma symptoms supplemented with a computed tomography (CT) or magnetic resonance imaging (MRI) showing PC and WOPN. Endoscopic ultrasound (EUS)- or CT-guided sampling of fluid can be used if imaging is unclear. Results of fluid analysis will show elevated amylase and low carcinoembryonic antigen (CEA) levels. If infection is suspected, gram staining may be useful. Treatment can include endoscopic cystgastrostomy or cystduodenostomy, percutaneous approach with CT-guided placement of drains done by interventional radiology, formation of a cystgastrostomy or cystenterostomy, or embolization depending on the symptoms and complications of the disease.