Pancreatic pseudocyst: the controversial value of total parenteral nutrition.
OBJECTIVE
Total parenteral nutrition (TPN) for the non-operative treatment of acute pancreatic pseudocyst has been of hypothetical benefit.


METHODS
We reviewed pseudocyst hospital admissions in 40 patients treated with TPN who had serial imaging studies. The mean cyst size was 7.4 cm on presentation, decreasing to 5.6 cm after non-operative treatment with TPN (mean 32.5 days).


RESULTS
After a non-operative period, 68 percent of pseudocysts regressed, completely in 14 percent, partially in 54 percent. Except for a patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complication, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), in the course of hospitalisation.


CONCLUSIONS
The majority of TPN-related patients had a clinical and radiographic regression of their pseudocysts. However, the increased risk of catheter-related complications in this group suggests that this therapy should be limited to patients who are unable to sustain enteral nutrition.
Shahrudin
M D
MD
Department of Surgery, Faculty of Medicine, University of Malaya.
Noori
S M
SM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects; D002779:Cholestasis / Q000209:etiology; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D006872:Hydropneumothorax / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000295:instrumentation; D010343:Patient Admission; D011030:Pneumothorax / Q000209:etiology; D012074:Remission Induction; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography