The traditional surgical method of therapy for pancreatic pseudocysts requiring drainage has been the transgastric cystogastrostomy, although percutaneous drainage of pseudocysts with CT or sono-

graphic guidance is now being performed more frequently. The surgical procedure requires that the pseudocyst have a thick, well-formed wall and be firmly attached to the posterior gastric wall. A communication of 2 to 8 cm is made between the posterior gastric wall and the adjacent pseudocyst by stabbing alone, by reinforcement of the margins with sutures, or by excision of a segment of gastric and cyst wall with oversewing of the edges to create a stoma. Occasionally, a temporary drainage tube is left through the opening.

The radiographic findings will vary depending on the surgical technique employed, the size of the communication and the size of the pseudocyst [63]. Barium may enter the cyst on upper GI series during the second or third week after surgery and may be seen up to 6 weeks after surgery when the pseudocysts are large and when reinforced or oversewn anastomoses have been performed (Figs. 3.60-3.62). Some cases will show deformity of the gastric contour and distortion of the

Figure 3.60. Cystogastrostomy. Film from an upper GI series 2 weeks after surgery demonstrates the entrance into the pseudocyst of contrast medium from the stomach.
Figure 3.61. Cystogastrostomy. Film from an endoscopic retrograde cholangiopancreatogram showing contrast medium entering the pseudo-cyst from the endoscope passed from the stomach through the surgically created communication to the pseudocyst.
Figure 3.62. Cystogastrostomy. (A) Right anterior oblique view from an upper GI series shows extraluminal contrast medium extending from the stomach into the pancreatic pseudocyst. (B) CT scan on the same patient.
Figure 3.63. Cystogastrostomy. Supine view from a single-contrast upper GI series shows deformity of the lesser curvature of the body of the stomach following cystgastrostomy.

rugal folds at the site of surgery (Fig. 3.63). In the healing stage, an area of rigidity, which may be flat, smooth, or irregular, may be observed. A localized sacculation or a gastric pseudodiverticulum has also been described.

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