A 45-year-old man with alcoholic chronic pancreatitis has a symptomatic pseudocyst. At what point after the acute episode is internal drainage (cystogastrostomy or cystojejunostomy) considered appropriate?

• A Immediately on diagnosis, whatever the age of the collection
• B Never, pseudocysts must always be drained externally
• C Only after 12 months of conservative care
• D After 6 weeks, once the wall has matured ✓

Explanation

A pseudocyst lacks a true epithelial lining, and its fibrous wall takes about 6 weeks to mature sufficiently to hold sutures for an internal drainage anastomosis. Draining earlier risks anastomotic breakdown and bleeding. Persistent symptoms beyond 6 weeks with a mature-walled collection is the classic indication for cystogastrostomy or cystojejunostomy. External drainage is reserved for infected or immature collections, not routine practice.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.