A 40-year-old man presents 3 weeks after an attack of severe acute pancreatitis with a symptomatic peripancreatic fluid collection of 8 cm. CT shows it lacks a well-defined enhancing wall. The most appropriate initial plan is:

• A Endoscopic cystogastrostomy within the week
• B Percutaneous catheter drainage now
• C Conservative management and reassess after 6 weeks ✓
• D Laparoscopic deroofing of the collection

Explanation

An immature collection at 3 weeks without a defined fibrous capsule is an acute peripancreatic fluid collection, not a pseudocyst. Most resolve spontaneously, so observation is correct unless there is infection or organ failure. Interventional drainage requires a mature wall, which takes roughly 4 to 6 weeks to form, otherwise drain placement risks failure, leak and recurrence. Once a mature symptomatic pseudocyst persists beyond 6 weeks, internal drainage by endoscopic cystogastrostomy becomes appropriate.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.