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Gastroenterology


Answer 3
  1. Observation. Pseudocysts develop in approximately 10% of patients who experience pancreatitis. Cysts can cause pain, become infected, leak, compress adjacent organs, bleed, and even erode into the mediastinum. Cysts greater than 5 to 6 cm in diameter are associated with a 30% to 50% risk of developing complications. Because of the patient’s lack of symptoms, small cyst size, and relatively recent previous episode of acute pancreatitis, observation is the most appropriate next step in managing his pancreatitis. Endoscopic, percutaneous, or surgical drainage of pseudocysts is sometimes warranted when cysts become painful or infected, but these procedures are not indicated in this patient because his cyst is small and he is asymptomatic. Distal pancreatectomy and cyst removal is, likewise, too drastic a measure in this patient. Serial CT scans might show the cyst to resolve on its own in the coming months. Evidence of cyst-related complications may warrant invasive management in the future, but not at the present time.

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