As a result of the local necrosis that occurs at the time of acute pancreatitis, collections of fluid may form in the vicinity of the pancreas. These become walled off by fibrous tissue and are called pancreatic pseudocysts. They are the most common type of pan-creatic cysts. Less common cysts occur as a result of congenital anomalies or are secondary to chronic pancreatitis or trauma to the pancreas.
Diagnosis of pancreatic cysts and pseudocysts is made by ul-trasound, computed tomography, and ERCP. ERCP may be used to define the anatomy of the pancreas and evaluate the pa-tency of pancreatic drainage. Pancreatic pseudocysts may be of considerable size. Because of their location behind the posterior peritoneum, when they enlarge they impinge on and displace the stomach or the colon, which are adjacent. Eventually, through pressure or secondary infection, they produce symptoms and re-quire drainage.
Drainage into the gastrointestinal tract or through the skin and abdominal wall may be established. In the latter instance, the drainage is likely to be profuse and destructive to tissue because of the enzyme contents. Hence, steps must be taken to protect the skin near the drainage site from excoriation. Ointments pro-tect the skin if they are applied before excoriation takes place. Another method involves the constant aspiration of digestive secretions from the drainage tract by means of a suction appa-ratus, so that skin contact with the digestive enzymes is avoided. This method requires expert nursing attention to ensure that the suction tube does not become dislodged and suction is not in-terrupted. Consultation with an enterostomal therapist is indi-cated to identify appropriate strategies to maintain drainage and protect the skin.