A 40-year-old alcoholic man recovered from severe acute pancreatitis 8 weeks ago now has persistent early satiety and vomiting. CT shows a mature, well-defined 9 cm peripancreatic collection with a thick enhancing wall compressing the stomach. There is no infection and no pseudoaneurysm. The most appropriate intervention is:

• A Percutaneous pigtail catheter drainage
• B Distal pancreatectomy with splenectomy
• C Continued observation with repeat imaging at 6 weeks
• D Internal drainage by endoscopic or surgical cystogastrostomy ✓

Explanation

A symptomatic pseudocyst persisting beyond 6 weeks with a mature wall is an established indication for drainage, and internal drainage by cystogastrostomy or cystojejunostomy, increasingly done endoscopically, is preferred. Observation is appropriate only for asymptomatic pseudocysts under 6 cm, since many resolve spontaneously. Percutaneous external drainage risks a persistent pancreaticocutaneous fistula and recurrence. Resection is reserved for pseudocysts confined to the tail or those with suspected malignancy, and adds unnecessary morbidity here.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.