[The pancreatic pseudocyst--late complication of the severe acute pancreatitis. Therapeutic options].

AIM:the assessment of the therapeutical methods in the pancreatic pseudocyst occurred after severe acute pancreatitis. MATERIAL AND METHOD:30 (33.3%) pancreatic pseudocysts (18 men and 12 women aged between 28-64) occurred in the evolution of 90 severe acute pancreatitis in the last 5 years (2000-2004) were analyzed. The diagnosis was established on the clinical and imaging aspects on average 1 month after the onset of the severe acute pancreatitis. The treatment was different, depending on size, anatomo-clinical form, pseudocyst age, presence of complications and the biological status of the patient. 14 uncomplicated pseudocysts, with the diameter less than 6 cm, were treated conservatively, until their complete resorption. 6 cases were operated on (2 cysto-gastrostomy, 1 cysto-jejunostomy and 3 external drainage). We performed percutaneous external CT guided drainage in 2 cases and endoscopic drainage in other 8 cases (trans-papillary-trans-ductal drainage 3 cases and endoscopic US guided drainage in 5 cases: transgastric 2, transduodenal 2 and transesophageal 1). RESULTS:28 (93.3%) cases had a fair evolution (complete resorption in 14 uncomplicated pseudocysts after 3-6 weeks of conservative treatment). We registered 2 gastro-duodenal bleeding during endoscopic US guided drainage, which required operation (haemostasis cysto-gastrostomy). Mortality rate was 0. CONCLUSIONS:1. The pseudocyst is the main late complication of the severe acute pancreatitis (33.3% in our study). 2. The uncomplicated pseudocysts with the diameter less than 6 cm, benefit of the conservative treatment and monitoring in progress until their complete resolution. 3. There are 3 therapeutical methods for the pseudocysts more than 6 cm in diameter and/or complicated: the percutaneous external US/CT guided drainage, the endoscopic drainage and surgery. 4. The option for the drainage procedure must take into account the morphological and evolutionary aspects of the pseudocyst, the age and biological status of the patient.