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Fifth Annual Samuel Jason Mixter Lecture

Alexander J. Walt, MB ChB; David L. Bouwman, MD; Donald W. Weaver, MD; Robert J. Sachs, MS

Arch Surg. 1990;125(6):759-763.

Abstract
• The records of 299 patients with 357 admissions for pancreatic pseudocysts seen between 1960 and 1989 were studied; 233 patients underwent operation. The natural history of pancreatic pseudocysts has been clarified by newer technology, such as ultrasonography, computer tomography, amylase isoenzyme measurements, and endoscopic retrograde cholangiopancreatography. All have influenced diagnosis, nonoperative management, and surgical operation. Differences between pancreatic pseudocysts associated with acute pancreatitis in contrast with chronic pancreatitis, and the complications of obstruction, hemorrhage, rupture, pancreatic ascites, infection, and jaundice can now be more rationally treated. Pancreatic pseudocysts and pancreatic ductal changes are now revealed earlier, especially by endoscopic retrograde cholangiopancreatography. Paradoxically, this information has encouraged nonoperative conservative therapy and also larger operations, eg, resection and adjunctive pancreaticojejunostomy. Partial resection of the pancreas together with the pancreatic pseudocysts was performed in 58 (25%) of the 233 patients. Recent technology permits cautious exploration of selective pancreatic pseudocyst drainage percutaneously or transgastroduodenally avoiding laparotomy.

(Arch Surg. 1990;125:759-763)

Author Affiliations
From the Department of Surgery, Wayne State University School of Medicine, Detroit, Mich.

Footnotes
Accepted for publication December 30, 1989.

Read before the 70th Annual Meeting of the New England Surgical Society, Bretton Woods, NH, September 23, 1989.

Reprint requests to Department of Surgery, Wayne State University School of Medicine, 6-C University Health Center, Detroit, MI 48201 (Dr Walt).

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