Pancreatic Fluid Collection

Pancreatic Fluid Collection

WHAT IS A PANCREATIC FLUID COLLECTION?

A pancreatic fluid collection is when fluids collect within the pancreas where they don’t belong. There are several types of pancreatic fluid collections. These include:

• Pseudocysts – The most common type, these fluids are not contained within an epithelial layer (a layer of skin cells) surrounding and containing them. These usually result from an injury to the pancreas.
• Walled off pancreatic necrosis (WOPN) also known as a pancreatic abscess – Filled with solid debris, these are often the result of acute pancreatitis. These usually result from an injury to the pancreas. They usually do not resolve on their own without surgical intervention.
• Inclusion cysts – These are benign and do not need to be removed.
• Cystic neoplasms – There are three types of cystic neoplasms, and they are typically slow to grow. These must be tested to make certain they are not malignant:
  • Intraductal papillary neoplasms (IMPN) – This is a type of tumor that can form within the cells of the pancreatic duct. IPMN tumors produce mucus that can form pancreatic cysts. Although IMPNs are benign tumors, they can progress to pancreatic cancer.
  • Mucinous neoplasms (MCN) – This is a type of tumor that is also referred to as low-grade appendiceal mucinous neoplasms (LAMNs), or appendiceal neoplasms of uncertain malignant potential.
  • Serous cystadenoma (SCA) – Ovarian serous cystadenoma, also known as serous cystadenoma or ovarian cysts, is the most common ovarian neoplasm, representing 20% of ovarian neoplasms, and is benign.

At Loma Linda University, our board-certified specialists are leaders in the treatment of pancreatic conditions. We have the ability to diagnose and treat pancreatic fluid collection in addition to other underlying pancreatic conditions.   

WHAT ARE THE SYMPTOMS OF PANCREATIC FLUID COLLECTION?

Some fluid collections can be small and not cause any symptoms. Large fluid collections may cause:

• Abdominal pain
• Fevers
• Indigestion
• Vomiting
• Weight loss

WHAT CAUSES PANCREATIC FLUID COLLECTION?

Pancreatic fluid collections are often caused by an injury to the pancreas. However, both acute and chronic pancreatitis can also lead to pancreatic fluid collection.

HOW IS PANCREATIC FLUID COLLECTION DIAGNOSED?

Diagnosing a pancreatic fluid collection starts with a medical history to determine if you have had an injury, or acute pancreatitis that could lead to a fluid collection.  

An image of the pancreas will show if you have a fluid collection. The image may be obtained through one of the following diagnostic tests:

• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Endoscopic ultrasound (EUS)

The first two methods are painless and non-invasive, and patients are awake during these tests. If the doctor elects to perform endoscopic ultrasound in order to collect a sample of the fluid, the patient may be sedated.

At Loma Linda University Health, we offer the full range of diagnostic and treatment services, including minimally invasive procedures for pancreatic cysts found only in major metropolitan academic medical centers.

HOW IS PANCREATIC FLUID COLLECTION TREATED?

There are several options for the treatment of pancreatic fluid collections. This includes starting with nutritional support by way of oral feeding, enteral feeding or Jejunal feeding. Other options are available depending on the type of pancreatic fluid collection being treated.

Drainage Options

• Endoscopic ultrasound (EUS) guided drainage – Using a flexible endoscope with an ultrasound probe at the end, the fluid collection can be assessed and drained.  
• Surgical cystogastrostomy – Using an open or laparoscopic procedure in which an anastomosis is created between the lumen of the cyst cavity and the stomach or small bowel using suturing or stapling devices. Depending on the location, a cystojejunostomy can also be a surgical alternative.
• Percutaneous drainage – Placing an external drainage catheter into the pseudocyst using real-time imaging guidance, usually with computed tomography (CT) or ultrasound (US) with fluoroscopy. 

Stents

• Endoscopic ultrasound with stent placement – Both metal and plastic stents are available, though metal stents may offer an advantage. When necrosis is present within the fluid collection, minimally invasive direct endoscopic necrosectomy (DEN) may be required in addition to drainage. Certain metal stents allow for direct endoscopic necrosectomy through the stent and are preferred in these patients. When a pancreatic duct leak is suspected, endoscopic investigation and stenting is necessary.
• Fully-covered self-expanding metal stents (FCSEMS) – These offer two advantages over traditional plastic stents. First, they allow for a larger drainage device, which decreases the risk of stent blockage and reduces the need for repeat procedures. Second, they allow for shorter procedure times since they require only a single access point of the cyst, rather than the multiple access points required with the use of multiple plastic stents.

At Loma Linda University Health, we offer the most advanced treatments and technologies found only in major metropolitan academic medical centers. Our specialists are all board-certified in gastroenterology and surgery with advanced training and experience in this area.

WHAT ARE THE COMPLICATIONS OF PANCREATIC FLUID COLLECTION?

If left untreated, complications of pancreatic fluid collections can be:

• Pain
• Biliary Obstruction
• Infection
• Rupture
• Hemorrhage

WHO IS AT RISK FOR PANCREATIC FLUID COLLECTION?

People most at risk for developing pancreatic fluid collections are those who suffer from:

• Acute pancreatitis
• Chronic pancreatitis
• A pancreatic injury

NEXT STEPS

• Stay aware. If you have had a pancreatic injury or are currently living with pancreatitis, you are in the risk category for this condition. Stay aware of the symptoms of pancreatic fluid collection and seek medical attention immediately if you begin experiencing them.  
• Seek medical intervention. If left untreated, pancreatic fluid collection can lead to more serious complications. To request an evaluation at Loma Linda University Health, contact your provider or schedule the appointment through MyChart.