Pseudocyst options

[Guest guest]

Some questions and a little venting. Got the MRCP I'd been waiting for ever

since my

January ERCP found panc duct too compressed to enter and was unable to drain my

pseudocysts. Met with surgeon this week, but he would only say that its up to

ME whether

or not I want him to operate to drain the two largest cysts. Said I could

consider

symptoms I feel, such as discomfort, pain, nausea. i tried asking whether

findings of

ERCP & MRCP such as compression of duct and partial compression of doudenum

would

be a factor, but he just repeated his first statement.

The report of March MRCP says largest cyst has a slight increase in size from

last CT Scan

Dec 04, and says its now 10.5 x 11.0 cm. The CT scan described the larger as 10

x 7.6 cm

and a Nov 04 Ultrasound gives 3 dimensions: 10.6 x 7.8 x 4.8 cm. The March

MRCP

report says the smaller one is 3.8 x 3.5 cm. It says that's same size as in the

earlier CT

scan, but written report of that scan just gives one dimension, 5 cm and the u/s

said 5 x

2.7 x7. These dimension differences may not be significant as I presume the

techs or

docs writing the reports may refer to the actual images in making comparisons.

There

also could be differences between technician's making the measurements or

differences

could be due to the more accurate picture MRCP gives over CT and U/S. It has

been

conjectured that the two cysts communicate, so I suppose one may even get

smaller as

other gets larger and that they also change shape. Incidentaly, previous scans

said I have

several other very small pseudocysts.

I know from the literature that current practice is to base pseudocyst surgery

decisions

less on size and principally on symptoms, but I thought that " symptoms " could

mean more

than just those I can sense. Anyway, since I have no nausea and only one

short bout of

mild pain in last 3 months, the surgeon and I agreed to watch-and-wait, with a

CT scan

scheduled in 3 months. If that shows cysts continuing to increase in size, or i

experience

more symptoms than I do now, he said he'd recommend drainage.

I realize that if I do experience significant pain again, there is no assurance

that the cysts

are the cause. In an accompanying post I ask about haitic hernia as a possible

cause.

At a previous visit I was told the surgery would involve at least a one week

hospital stay. I

was hoping to find out a little about the surgical method and what I might

experience

post-op, so i could be prepared to ask some intelligent questions at the time i

have to

make a decision, but he refused to discuss anything about it until i agree to

the surgery. I

finally got him to say whether drainage would be inside or outside body. He

said it would

be to the intestine. This confuses me, as I've been told one reason endoscopic

drainage to

stomach or doudenum is not feasible is because my cysts are not close enough to

the

stomach or doudenum walls. Has anyone had pseudocyst surgery done by cut from

the

outside but with drain placed to doudedum (or some other part of intestine) or

can tell me

how that might be done and what to expect?

By this time I was pretty frustrated with having to make a decision with so

little

information, but realized I was not going to get anything else from the

conversation.

When the endoscopic specialist referred me back to the surgeon, she felt I

should get cysts

drained, and Heidi told me in December I should seriously consider that because

of the

possible consequences of a rupture of a large cyst, but agreed it was if a tough

decision if

little symptoms. I also realize my condition could revert to chronic at some

time in the

future. If its a factor, I am 65 years old, and always in good health until my

acute attack

last year. I have been told by another GI that my surgeon is best and maybe

only

pancreas specialist in our city, but if I can't get better communication I may

want to get an

opinion from another surgeon or pancreas specialist. Can anyone suggest one in

Sacramento or the San Francisco area, especially one that communicates?

Kurt (CA)

[Guest guest]

Kurt ,

I have the same problem with pseudocysts and was told that because of the

location of mine endoscopic drainage is not possible. The only options that

are available to me are to keep getting them aspirated (This drains the

pseusdocyst and for me relieves the pain temporarily) or surgery. Have you

tried to get the large pseudocyst aspirated because there is a chance that

if they aspirate it, it will not return, but there is also a chance that if

the pseudocysts are aspirated they will return larger then they were

originally (that is what happens with me). I keep getting them aspirated

tho to relieve the pain, but I am told that if I am not haveing major pain

then the best thing to do with the pseudocysts is a " wait and see " approach.

The surgery option was just explained to me at my last visit to the GI, he

said that they will link the psuedocysts and in my case the tail odo the

pancreas into my intestents in such a way that it drains there. This option

is a major surgerical one, that takes a long recovery period.

I don't know if this info helped at all, but I hope that it does

a

>

> At a previous visit I was told the surgery would involve at least a one

> week hospital stay. I

> was hoping to find out a little about the surgical method and what I might

> experience

> post-op, so i could be prepared to ask some intelligent questions at the

> time i have to

> make a decision, but he refused to discuss anything about it until i agree

> to the surgery. I

> finally got him to say whether drainage would be inside or outside body.

> He said it would

> be to the intestine. This confuses me, as I've been told one reason

> endoscopic drainage to

> stomach or doudenum is not feasible is because my cysts are not close

> enough to the

> stomach or doudenum walls. Has anyone had pseudocyst surgery done by cut

> from the

> outside but with drain placed to doudedum (or some other part of

> intestine) or can tell me

> how that might be done and what to expect?

[Guest guest]

Kurt-

I had a pseudocyst drained by Endoscopic Ultra Sound - Fine Needle

Aspiration. (EUS/FNA) about a month ago at California Pacific Medical

Center in San Francisco.It is suppose to be much easier on you than

an ERCP. It was a pretty uncomfortable procedure. They didn't sedate

me near enough to my liking! Dr Binmoeller did the procedure.

My GI Dr in Redding sent me to him. I wasn't very impressed by him

(of course I was so nervous about having the procedure done I forgot

to ask the questions I had planned to ask). But, he didn't seem to be

very communicative. I'm not really thrilled with my GI Dr either

though. I was having pain & nausea before the procedure. Now I'm

having more pain and nausea. I go in for another CT scan next week to

see if it has come back or not.

I'm considering going to Stanford. I've read that they have a good GI

Department and that they treat a lot of pancreatitis cases. It sure

would be nice not to have to play Dr roulette wouldn't it?

Kimber gave me some Phone numbers of a couple of Drs in the bay area

if you want them. Just e-mail me and I would be glad to give them to

you.

I hope the best for you,

Rhonda

[Guest guest]

> Kurt ,

> I have the same problem with pseudocysts and was told that because of the

> location of mine endoscopic drainage is not possible. The only options that

> are available to me are to keep getting them aspirated

>

> The surgery option was just explained to me at my last visit to the GI, he

> said that they will link the psuedocysts and in my case the tail odo the

> pancreas into my intestents in such a way that it drains there. This option

> is a major surgerical one, that takes a long recovery period.

a,

Do you know if this involves cutting & spicing intestine something like the

whipple or

beger procedures I've read about? If not, then as I said, I don't understand

how my

surgeon is expecting to drain my cysts to intestine. I was told earlier by my

GI that one

reason endoscopic drainage is out is because my cyst walls are too far from

intestine or

stomach. Maybe when they do operation by full surgery they can use some longer

or more

permanent type of stent than can be inserted endoscopically?

Since surgeon is so uncommunicative, I did not ask about needle aspiration, but

I'm pretty

sure that's out because the MRI and CTs show my cysts contain heavy amount of

debris

which must be flushed out as part of the procedure.

Kurt