A 40-year-old man recovering from severe acute necrotising pancreatitis develops a persistent collection in the lesser sac. He is now 5 weeks from onset, feeding normally, and the collection measures 4 cm and is asymptomatic. The most appropriate management is:
- A Observation, since most such collections resolve spontaneously ✓
- B Percutaneous catheter drainage to prevent infection
- C Urgent endoscopic cystogastrostomy
- D Open internal drainage via cystojejunostomy
Explanation
C well-defined fluid collection persisting beyond four weeks after necrotising pancreatitis qualifies as a pancreatic pseudocyst. Asymptomatic pseudocysts, even up to 6 cm, should simply be observed because the majority resolve spontaneously. Intervention is reserved for persistent symptoms such as pain, gastric outlet obstruction, or jaundice, or for complications like infection, haemorrhage, or rupture. Drainage, whether endoscopic, percutaneous, or surgical, carries morbidity and is inappropriate in an asymptomatic patient. Cystogastrostomy also requires a mature wall and apposition to the stomach.
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.