Abstract
We classify pancreatic pseudocysts in 3 types: post-necrotic type I, related to acute pancreatitis; post-necrotic type II, related to an acute attack superimposed on chronic pancreatitis; and retention type III, due to chronic pancreatitis with ductal stricture. A prospective study on percutaneous catheter drainage of post-necrotic pseudocysts (type I and II) was undertaken from 1987 to 1990. Twenty-three pseudocysts in 21 patients were drained. Overall recurrence rate was 4%; 2 patients had fistulization of the catheter into bowel; no deaths occurred. The procedure was successful in all type I cysts; in type II cysts it was associated with prolonged drainage and increased risk of complications when cyst-duct communication was present. Percutaneous drainage has no role to play in type III retention cysts. Guidelines regarding indications for treatment and the techniques employed are described.
Résumé
Nous avons classé les pseudokystes pancréatiques en trois groupes: type I: postnécrotique, secondaire à une pancréatite aiguë, type II: postnécrotique secondaire à une poussée aiguë sur pancréatite chronique, et type III: rétentionel, en rapport avec une sténose du canal de Wirsung au cours d'une pancréatite chronique. Une étude prospective sur le drainage percutané des pseudokystes nécrotiques: (type I et II) a été entreprise entre 1987 et 1990. Vingt trois pseudokystes chez 21 patients ont été drainés. Le taux de récidive global a été de 4%. Une fistulisation kysto-entérique s'est produite chez deux patients sans entrainer de déces. Le procédé a été couronné de succès dans tous les pseudokystes du type I. Lorsqu'il s'agissait d'un pseudokyste de type II, le drainage a été souvent prolongé, et des complications ont été plus fréquentes lorsqu'une communication kysto-canalaire était présente. Le drainage percutané n'a aucun rôle à jouer dans les pseudokystes du type III. Des recommandations quant aux indications et la technique à employer sont décrities.
Resumen
Clasificamos los seudoquistes pancreáticos en tres tipos: “Tipo I, post-necrótico”, el que está relacionado con pancreatitis aguda; “Tipo II, post-necrótico”, el que está relacionado con un ataque agudo en un paciente con pancreatitis crónica; “tipo III, de retención”, el que se debe a pancreatitis crónica con estenosis ductal. Se realizó un estudio prospectivo sobre el drenaje percutáneo con catéter de los quistes post-necróticos (tipos I y II) entre 1987 y 1990. Se drenaron 23 seudoquistes en 21 pacientes. La tasa global de recurrencia fue 4%; dos pacientes desarrollaron fistulización del catéter al intestino; no se presentaron muertes. El procedimiento fue exitoso en todos los quistes tipo I; en los quistes tipo II apareció asociado con drenaje prolongado y con un mayor riesgo de complicaciones cuando había comunicación quiste-canal pancreático. El drenaje percutáneo no está indicado en los quistes de retención tipo III. Se describen las directrices en cuanto a tratamiento y a las técnicas empleadas.
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D'Egidio, A., Schein, M. Percutaneous drainage of pancreatic pseudocysts: A prospective study. World J. Surg. 16, 141–145 (1992). https://doi.org/10.1007/BF02067130
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DOI: https://doi.org/10.1007/BF02067130