THE LIMITED ROLE OF TOTAL PARENTERAL-NUTRITION IN THE MANAGEMENT OF PANCREATIC PSEUDOCYST

Total parenteral nutrition (TPN) for the nonoperative treatment of acu te pancreatic pseudocyst has been of hypothetical benefit. We reviewed pseudocyst hospital admissions in 40 patients treated with TPN who ha d serial imaging studies. The mean cyst size was 7.4 cm on presentatio n, decreasing to 5.6 cm after nonoperative treatment with TPN (mean 32 .5 days). After a nonoperative period, 68 per cent of cysts regressed, completely in 14 per cent, partially in 54 per cent. Except for a pat ient 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 r ight atrial thrombosis (2%), in the course of hospitalization. The maj ority of TPN-treated patients had a clinical and radiographic regressi on of their pseudocyst. However, the increased risk of catheter-relate d complications in this group suggests that this therapy should be lim ited to patients who are unable to sustain enteral nutrition.