Pancreatic Pseudocysts and Panniculitis: Understanding PPP Syndrome

The pancreas is an organ that sits behind your stomach. It makes fluids that flow through a duct into the small intestine. These fluids help you digest food. The pancreas also releases hormones to help control blood sugar. This includes insulin. Panniculitis, polyarthritis, and pancreatitis (PPP) syndrome is a triad comprising of extra-pancreatic complication of pancreatic pseudocysts.¹

Pancreatitis occurs when there is inflammation of the pancreas. When the pancreas gets inflamed, it may leak digestive enzymes. This damages the pancreas. This causes collections of fluid to form. These are called pancreatic pseudocysts.²^,³ Pancreatic pseudocyst is a common complication of chronic pancreatitis. Pancreatic pseudocyst can present single or multiple, inside or outside the pancreas.⁴^,⁵^,⁶^,⁷

They are filled with amylase rich fluid.⁸ Symptoms of pseudocysts are typically non-specific and may present only with vague abdominal pain, nausea, or vomiting.

Pancreatic pseudocysts are different from true pancreatic cysts. Both cysts and pseudocysts are collections of fluid. A true cyst is a closed structure. It has a lining of cells that separates it from the nearby tissue. A pseudocyst isn’t closed and doesn’t have a lining of epithelial cells separating it from the nearby tissue.

Chronic pancreatitis (CP) is an inflammatory disease causing structural and functional damage resulting in exocrine and endocrine deficits.⁹ Pancreatic pseudocysts are collections of leaked pancreatic fluids. They may form next to the pancreas during pancreatitis. Pseudocysts form when the cells of the pancreas become inflamed or are injured and pancreatic enzymes start to leak. Leaking of the enzymes harms the tissue of the pancreas.

Pseudocysts must be suspected in patients who have persistent abdominal pain or consistently elevated levels of pancreatic enzymes.¹⁰ Most pseudocysts resolve spontaneously with supportive care.¹¹

This causes some of the pancreatic fluid to leak out into your abdominal cavity. The fluid collects between the walls of your organs, and a capsule forms around it, creating a pseudocyst.

Free intraperitoneal fluid is a secondary indication of abdominal disorders. In men, the primary causes of this fluid are pancreatitis and portal hypertension. In women, the main causes are pancreatitis, portal hypertension, and retrograde menstruation. The detection of small volumes of fluid has been documented as a normal finding in women of childbearing age and also in pediatric sonography. Small volumes of pelvic free fluid in healthy men can be normal and do not necessarily indicate underlying disorders.¹²^,¹³

References

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Gumaste VV, Pitchumoni CS. Pancreatic pseudocyst. Gastroenterologist. 1996 Mar;4(1):33-43. PMID: 8689144.
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Habashi S, Draganov PV. Pancreatic pseudocyst. World J Gastroenterol. 2009 Jan 7;15(1):38-47. doi: 10.3748/wjg.15.38.
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Brown SE, Dubbins PA. Detection of free intraperitoneal fluid in healthy young men. J Ultrasound Med. 2012 Oct;31(10):1527-30.
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Yoshikawa T, Hayashi N, Maeda E, Matsuda I, Sasaki H, Ohtsu H, Ohtomo K. Peritoneal fluid accumulation in healthy men and postmenopausal women: evaluation on pelvic MRI. AJR Am J Roentgenol. 2013 Jun;200(6):1181-5.

Pancreatic Pseudocysts and Panniculitis: Understanding PPP Syndrome

References

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