Pseudocysts and walled-off pancreatic necrosis are complications that can arise from acute pancreatitis. These are fluid-filled collections that develop in and around the pancreas, often as a result of inflammation and damage to pancreatic tissue.

Symptoms can often be vague but include:

• Abdominal pain.
• Fever.
• Signs of systemic inflammation.
• Feeling full quickly after eating.
• Nausea.

Diagnosis:

• Imaging studies, such as CT scans or ultrasound, are used to visualize and confirm the presence of a pseudocyst or walled off necrosis.

Pseudocysts:

Definition:

• A pseudocyst is a collection of fluid rich in enzymes, blood, and necrotic tissue that forms outside the pancreas.
• Pseudocysts are typically associated with acute pancreatitis.
• They can also result from pancreatic trauma, such as injury or surgery.

Walled-Off Pancreatic Necrosis (WOPN):

Definition:

• Walled-off pancreatic necrosis refers to a more severe condition where necrotic (dead) tissue is enclosed by a well-defined wall or capsule.

Complications of Pseudocysts and Walled-Off Pancreatic Necrosis:

• Infection: Both pseudocysts and walled-off pancreatic necrosis can become infected, leading to a more serious condition known as infected pancreatic necrosis.
• Bleeding: The blood vessels around the pseudocyst or necrotic collection may be damaged, leading to bleeding.
• Obstruction: The pseudocyst or necrotic tissue can compress surrounding structures such as the stomach, intestine or bile duct.

Management of pseudocysts and walled-off pancreatic necrosis requires a multidisciplinary approach involving gastroenterologists, interventional radiologists, and surgeons. The choice of treatment depends on the size, location, and clinical presentation of the collection. Timely intervention is crucial to prevent complications and improve outcomes in these severe pancreatic conditions.

Treatment:

1. Observation: Small, asymptomatic pseudocysts may be monitored without intervention.
2. Drainage: If the pseudocyst is large, causing symptoms, or at risk of complications, drainage may be performed. This can be done through endoscopic drainage or percutaneous drainage guided by imaging.
3. Surgery: In some cases, surgical drainage by connecting the fluid collection to the stomach or intestines or removal of the diseased part of the pancreas may be necessary. Dr. Sulzer and his team are the only providers in Western North Carolina to offer such procedures.