Contents
Removal of a pancreatic cyst belongs to the camp of radical treatment methods, when no other alternative approaches have had the desired effect.
From an anatomical point of view, a cyst is a formation limited by walls, which is localized in the parenchyma of an organ. Inside the formation is filled with liquid content. The development of such a pathology occurs for several reasons of a traumatic or inflammatory nature.
The symptomatology is directly related to how large the cyst is, as well as where exactly it is located. The reasons for the formation of pathology affect the rate of deterioration of well-being. Taking into account all of the above, it becomes clear why some patients simply complain of mild discomfort in the abdominal cavity, while others experience acute pain. Sometimes the disease is accompanied even by squeezing of neighboring organs.
Standard classification
To deal with the diameter of the affected area, its location, and also to find out if the focus of inflammation has touched neighboring soft tissues, modern diagnostic methods are used. They are considered an obligatory item of the plan before the appointment of a surgical intervention, which allows not only to study the problem in detail, but also to use the information collected during the operation itself.
The most productive diagnostic versions are computed tomography and magnetic resonance imaging, as well as ERCP. In the first two cases, the stage of adding a contrast agent is not mandatory, but the last type of analysis is completely based on it.
Only after receiving the visualization on hand, the treating specialist makes the final decision as to whether the operation is possible and which format will be the most effective. Most often, classical internal or external drainage is used. A little less often, experts resort to resection of a part of the pancreas along with a zone that threatens the entire body.
According to statistics, pancreatic cysts have been diagnosed much more often in recent years, and mostly young people become its victims. Researchers explain the sharp rejuvenation of patients in the gastroenterological inpatient department by the fact that young people began to suffer from acute and chronic pancreatitis more often. Moreover, their etiology varies from classical traumatic to biliary or acquired alcohol, which over the past ten years has become a real scourge among physicians.
According to the same statistical summary, a cyst is the most common consequence of a complication of chronic pancreatitis. It accounts for about 80% of clinical cases of the total number.
Difficulties are added by the fact that in the medical environment there is no single idea of which formations should be attributed to pancreatic cysts. Because of this, one general set of rules regarding the classification of such a pathology is not provided, as well as standards of pathogenesis with assistance.
Some adherents say that the cyst must have pancreatic juice inside, and also be limited to the walls. Others believe that the contents may even be necrotic parenchyma or:
- blood;
- manure;
- inflammatory exudate.
The only thing that both camps agree on is the principles of anomaly formation. They provide for the following conditions:
- parenchyma damage;
- problematic secretion outflow;
- local failure of microcirculation.
Separately, there is a classification of pathologies, which is divided according to the parameters of their formation. But even they have several divisions for the convenience of establishing a specific diagnosis. The main sorting provides for the division of diseases into the following types:
- congenital;
- inflammatory;
- traumatic;
- parasitic;
- neoplastic.
The first paragraph includes several more sub-paragraphs like dermoid and teratoid, as well as fibrocystic degeneration, adenomas, polycystic.
But the frequently occurring pseudocysts are a representative of a number of inflammatory categories, which also included retention options. Separately, there is a sorting for neoplastic versions, which affects the following subtypes:
- cystadenomas;
- cavernous hemangiomas;
- cystadenocarcinomas;
- epitheliomas.
All of them differ in the course of the disease, treatment measures, and approaches to rehabilitation therapy.
Features of each type
After a detected pathology, the doctor must get ahead of its type in order to then deal with a specific program of therapeutic measures. Some experts believe that a cyst after trauma is as complex as the identical course of events in acute or chronic pancreatitis. First, autolysis of the enzymatic format occurs on the affected area of the pancreatic parenchyma, followed by the formation of a loose infiltrate. It contains tissue breakdown products.
Over time, it turns into a kind of capsule, which provokes the emergence of a false cyst, which does not have a layer of lined epithelium. A real cyst communicates with the duct, being inside the pancreas, or outside if the size of the formation is too large.
Scientists never name the average size of such inflammation, since they can vary from giants with several liters of accumulated fluid to tiny objects, which is characteristic of polycystic disease. In the course of observations, the researchers came to the conclusion that in women, pancreatitis of any kind becomes the most common cause for such a verdict, and in men, abdominal trauma.
Congenital abnormalities are often found in children, as they try to show themselves as unpleasant symptoms from the very beginning. It is believed that this option is the logical conclusion of dysontogenesis. They occur both singly and in colonies.
At a particularly advanced stage, they are combined together with identical formations in neighboring organs:
- liver;
- kidneys;
- ovaries.
Even combinations with the brain have been recorded in clinical practice.
Traditional content implies a granular mass, cavities with dermioid tissues. The primary source of the problem is the incorrect formation of germinal anlages, such as individual glandular lobes that separate from the main mass of the gland. Sometimes they are ectopic in the gastric walls.
If we consider a kind of popularity rating, then the inflammatory type of formations becomes the leader of the list, for which one should “thank” the pancreatitis that has not been completely cured or left to chance. When a person has become a victim of its acute form, then degenerative processes contribute to the formation of an infiltrate, to which a capsule and cavities are later added.
The result of chronic pancreatitis looks a little different, expressed in islets of connective tissue, as well as in narrowing of the duct with periodic expansions. Because of this, already during the operation, the surgeon can decide to get rid of stones that block the normal transfer of the secret. They are so small that ultrasound does not notice them.
When the duct narrows inside the glandular lobe, an ordinary cyst is formed. But if there is a prestenotic expansion of the path, then a large spherical retention obstacle cannot be avoided. Its feature is called dense fibrous walls, a tight vascular sect, lining with cubic epithelium. The content of the lesion ranges from an almost clear liquid to a thick brown consistency.
Situations are much less common when the cause for formation is a parasitic influence. In fact, this only means the onset of the vesicular stage of development of echinococcus. Due to the impact of the latter, the head is often affected. But if cysticercosis was detected, then a body with a tail was hit.
Physiologically, the wall of the parasitic variant consists of a fibrous capsule, together with a chitinous membrane, created by the body itself. The only good thing here is that cystadenomas are among the rarest medical diagnoses in the gastroenterological part.
Based on the presented schematic classification, physicians develop a further strategy for providing assistance, choosing the optimal surgical intervention.
When is it time to see a doctor
The main source of numerous side effects after the operation is that the victim realized too late how deplorable the situation was. With problem areas up to 5 centimeters in diameter, people rarely complain of regular malaise or more serious health problems. Experiencing a sufficiently serious pain syndrome, which prompts you to sign up for a consultation with a specialized expert, is characteristic of larger cysts. They are also characterized by the so-called “light gap”, which means a temporary improvement in the picture after an acute attack or injury.
The most intense pain makes itself felt during the formation of a pseudocyst with the next steel of acute pancreatitis, or with an exacerbation of a chronic disease. This is explained by pronounced destructive phenomena. After a while, the intensity subsides, and the pain becomes more like a dull or aching pain.
In a particularly sad scenario, it is worth getting ready that, against the background of meager symptoms, intraductal hypertension will make itself felt. A sharp pain attack also suggests a possible rupture. If after that the victim experiences signs of normal intoxication along with an increase in temperature, then this indicates suppuration.
The clinical picture looks a little different with a normal pancreatic cyst, which pressed down on the solar plexus, which leads to:
- burning pain;
- recoil in the back;
- increased discomfort when squeezing clothing;
- relief when taking a knee-elbow posture.
Blocking the syndrome is obtained only with the help of analgesics of the narcotic spectrum of action, which are simply not available in the pharmacy.
Among the more understandable signs indicating the need to visit the gastroenterological department, there are:
- nausea;
- vomiting;
- chair instability;
- weight loss.
The latter occurs due to the fact that the exocrine function of the gland ceases to work normally, which disrupts the usual absorption of incoming nutrients into the intestine.
The final principle of detecting a dangerous disease is the syndrome of squeezing neighboring organs. When the cyst is located on the territory of the head of the pancreas, the probability of obstructive jaundice is too high, which is expressed in:
- jaundice of each integument, sclera;
- in a hurry
When normal access to the portal vein is blocked, edema develops in the lower extremities. No less threatening is the blockage of the outflow of urine through the ureters, which implies a delay in urination.
An exception to the rule is squeezing the intestinal lumen, but if this has already happened, then the patient will have intestinal obstruction with all the consequences.
Radical approach
As soon as the doctor rechecks the complaints of the ward, confirms the suspicions with the results of a diagnostic examination and concludes that alternative medicine is powerless here, the day of the operation will be scheduled. The type of surgical intervention will depend entirely on the physical, anatomical and classification features of a particular cyst.
Depending on the circumstances, the doctor prefers removal of the cyst or drainage. If the choice is made in favor of the first proposal, then the volume of tissues to be excised is additionally calculated. The basis for the calculations is the size of the formation and the state of the parenchyma, which allows you to choose the best method of removal:
- head resection;
- distal excision;
- pancreatoduodenal removal.
But surgeons try to resort to this type of intervention only after they are convinced that it will not work to save the organ with the help of drainage. Usually, drainage is carried out by imposing an anastomosis between the stomach and the cyst, which in medical terminology is called cystogastrostomy. There are variations of the anastomosis with the small intestine or duodenum.
From the point of view of physiology, the presented methods are more valuable, since they guarantee the passage of pancreatic secretions, eliminating pain manifestations along the way. An additional advantage is the low percentage of possible relapses.
But all this is characteristic of internal drainage, and external, which is carried out an order of magnitude less often, has completely different indications: suppuration of the cavity; unformed cyst; abundant vascularization; general severe condition.
It is not for nothing that such an operation is classified as a palliative rank, as it retains a rather high risk of developing pus along with a relapse. The inconvenience is added by an almost obligatory side effect in the form of pancreatic fistulas, which are almost impossible to remove with conservative methods.
But, regardless of the type of drainage, it is allowed to use it only after the non-tumor etiology of the detected object is confirmed.
The most innovative technologies are called minimally invasive removal analogues. But even such almost non-traumatic versions have a significant drawback – serious complications in the form of sepsis and external fistula.
Forecast of success
How productive the operation will be, as well as voice the speed of recovery, even an experienced specialist will not be able to. But he will definitely advise you to clearly adhere to the prescribed therapeutic diet, changing your lifestyle, getting rid of bad habits. By using replacement medications, analgesics, and regular glycemic monitoring as support, you can guarantee yourself a long life.
To make a forecast, the timeliness of the assistance provided, the professionalism of the team of medical workers, and the causes of the disease are also taken into account.
We will have to prepare for the fact that with some types of pancreatic operations, complications reach 50%. This is due to the development of perforation, suppuration, the occurrence of fistulas and even intra-abdominal bleeding. Even after a successful intervention, there is still a chance of a possible relapse.
To minimize this likelihood, you will need to give up alcoholic beverages, fatty, smoked, too salty and spicy foods. You will also need to carefully monitor the health of the gastrointestinal tract, regularly undergoing a control preventive examination. Only all together will not significantly reduce the quality of subsequent life.