Diagnosis

Ultrasound or CT scan usually makes the diagnosis of a pancreatic pseudocyst. CT scan is by far the most accurate test for detecting pseudocyst with a sensitivity of90-100% in contrast to ultrasonography that has a sensitivity of 75-90%. Ultrasound is often operator dependent and its use is limited in obese patients. On the other hand, given its convenience and lower cost, ultrasonography is the ideal method for monitoring pseudocyst size (14).

The role of endoscopic retrograde cholangiopancreatography (ERCP) following the diagnosis of a pancreatic pseudocyst remains controversial. Advocates for ERCP have reported a 95% advantage of demonstrating pancreatic ductal abnormalities and an 80% detection rate for duct-pseudocyst communication (15). Additionally, routine ERCP has been found to alter the operative plan for pseudocyst drainage in 24 of 41 patients, with 19 requiring a surgical drainage procedure (16). Furthermore, demonstration of ductal abnormalities, particularly ductal communication or stricturing of the main pancreatic duct plays a major role when considering internal drainage over a percutaneous drainage procedure (17). In contrast, ERCP has been demonstrated to exacerbate acute pancreatitis, resulting in bacterial seeding of fluid collections, and needlessly increase the extent of operation without a significant advantage in outcome (18,19).

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