Early, late or no surgery for the groove pancreatitis? experience of 86 cases of the cystic dystrophy of the duodenal wall

Groove pancreatitis is a segmental chronic pancreatitis that affects the groove area, classically the anatomical area between the pancreatic head, the duodenum, and the common bile duct. The etiopathogenesis remains elusive till date, though association with alcohol abuse has been described in literature. Imaging feature described include soft tissue mass in the groove, thickening of medial wall of duodenum, thus closely mimicking a neoplastic aetiology and hence posing diagnostic dilemma. However classic ndings of cystic changes in the groove extending to duodenal wall and brotic component can aid the radiologist in making an accurate diagnosis and thus avoiding unnecessary surgical intervention. Groove pancreatitis is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall.

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Pancreas-preserving duodenectomy as a treatment of choice for the isolated form of the cystic dystrophy of the duodenal wall (pure form of groove pancreatitis)

HPB ◽

10.1016/j.hpb.2020.04.384 ◽

2020 ◽

Vol 22 ◽

pp. S361-S362

Author(s):

Vyachesla Egorov ◽

R. Petrov ◽

A. Schegolev ◽

E. Dubova ◽

A. Vankovich ◽

...

Keyword(s):

Pure Form ◽

Duodenal Wall ◽

Groove Pancreatitis

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Groove Pancreatitis Associated with a Large Pseudocyst in the Muscular Layer of the Duodenal Wall: A Case Report

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.43.1252 ◽

2010 ◽

Vol 43 (12) ◽

pp. 1252-1257

Author(s):

Takahiro Terashi ◽

Hideki Ijichi ◽

Seiji Maruyama ◽

Rinshun Shimabukuro ◽

Yoshitada Ono ◽

...

Keyword(s):

Case Report ◽

Duodenal Wall ◽

Muscular Layer ◽

Groove Pancreatitis

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Groove Pancreatitis - Cause of Recurrent Pancreatitis

Internal Medicine ◽

10.2478/inmed-2019-0071 ◽

2019 ◽

Vol 16 (3) ◽

pp. 71-77

Author(s):

Georgiana Crișu ◽

Monica Grigore ◽

V. Balaban ◽

Andreea Zoican ◽

Marina Ciochina ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Rare Condition ◽

Inflammatory Cells ◽

Needle Aspiration ◽

Duodenal Wall ◽

Recurrent Acute Pancreatitis ◽

Rare Type ◽

Groove Pancreatitis ◽

Ca 19.9 ◽

Head Of The Pancreas

AbstractBackground. Groove pancreatitis or paraduodenal pancreatitis represents a rare type of pancreatitis, and can be classified into cystic dystrophy of the duodenal wall in heterotopic pancreas, paraduodenal cyst or myoadenomatosis.Case presentation. We present a case of a 58 year old man, drinker and smoker who was admitted in the Department of Gastroenterology for abdominal pain, weight loss and nausea. From his history we have noticed frequent presentations of recurrent acute pancreatitis in the last two years. Laboratory tests have revealed cholestasis, high value of lipase and high value of amylase, with normal value of CA 19.9. The magnetic resonance from the last two years showed the same appearances: a large and edematous head of pancreas, a thickening of the wall of adjacent duodenum and an inhomogeneous area with cystic transformation in the head of the pancreas. We performed endoscopic ultrasound with fine needle aspiration. The histopathological result showed only inflammatory cells. We have established the diagnosis of groove pancreatitis.Conclusion. Groove pancreatitis represents a rare condition, with an incidence of 0.4%-14% on biopsies. Endoscopic ultrasound is the best method for diagnosis, it could evaluate also the duodenal wall.

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Study of role of computerized tomography (CT) in evaluation of groove pancreatitis

MedPulse International Journal of Radiology ◽

10.26611/10132014 ◽

2021 ◽

Vol 20 (1) ◽

pp. 15-19

Author(s):

Swadeep Raj G ◽

Keyword(s):

Pancreatic Head ◽

Final Diagnosis ◽

Duodenal Wall ◽

Wall Thickening ◽

Imaging Findings ◽

Pure Type ◽

Groove Pancreatitis ◽

Hyperintense Signal ◽

Contrast Enhanced Ct ◽

Pancreatic Duct Dilatation

Background: Groove pancreatitis is a rare form of chronic pancreatitis affecting the groove between the pancreatic head, duodenum and common bile duct. The exact cause of the disease is not known, although there are strong associations with long term alcohol abuse, functional obstruction of duct of Santorini and brunner gland hyperplasia. The purpose of this study was to describe the imaging findings of groove pancreatitis (GP) on Contrast enhanced CT Abdomen. Material and Methods: Present study was retrospective study conducted, with help of medical records of 16 patients with a final diagnosis of Groove pancreatitis. CT, MRI and MRCP findings were analysed. Statistical analysis was done using descriptive statistics. Results: In present study, two types of groove pancreatitis (GP) as pure type (50%) and segmental type (50%) were noted. Other important findings were focal duodenal wall thickening (62.5%) and cysts in the duodenal wall itself or in groove between the pancreatic head and the duodenum (37.5%), CBD dilatation and distal smooth tapering (62.5%) including all the segmental types and 2 of the pure type leading to intra- and extra-hepatic biliary system dilatation. MRI and MRCP were available in 6 patients in our study. There was a CT similarity regarding the sheet of tissues within the pancreaticoduodenal groove. These were seen expressing T1 hypo-intense and T2 slightly hyperintense signal in 3 patients with depiction of mild enhancement in the delayed phases in three of them (50%). On the MDCT examinations hypodense sheet at the PD groove was seen in 12 patients with modest enhancement identified in delayed phase seen in 6 of the them. Duodenal wall thickening was seen in 10 patients while associated cysts within the duodenal wall or in PD groove were seen in 6 patients. Pancreatic head enlargement with diffuse enhancement was seen in 8 patients. Mild pancreatic duct dilatation was seen in 8 patients while dilatation of the CBD was seen in 10 patients with distal tapering and intra-hepatic biliary dilatation. Conclusion: Groove pancreatitis (GP) is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall. Imaging findings that are suggestive of GP include chronic inflammatory changes with fibrosis in the PD groove with or without implication of the nearby head of the pancreas, duodenal medial mural thickening with luminal stenosis and cysts at the PD groove or within the duodenal wall.

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GROOVE PANCREATITIS MASQUERADING AS CARCINOMA PANCREAS : A DIAGNOSTIC DILEMMA

10.36106/ijsr/3206483 ◽

2020 ◽

pp. 1-2

Author(s):

Lohith P ◽

Rajshekar P ◽

Deepak Ghuliani ◽

Ravindra K Saran

Keyword(s):

Pancreatic Cancer ◽

Chronic Pancreatitis ◽

Duodenal Obstruction ◽

Signs And Symptoms ◽

Duodenal Wall ◽

Management Approach ◽

Clinical Response Rate ◽

Diagnostic Dilemma ◽

Groove Pancreatitis ◽

Whipple’S Procedure

INTRODUCTION: Groove pancreatitis(GP) is a rare special form of chronic pancreatitis localised to pancreaticoduodenal groove, presents commonly with signs and symptoms of duodenal obstruction, mimicks pancreatic cancer radiologically and the surgeon proceeds with inadvertent whipples procedure. PRESENTATION OFCASE: A28yr old gentleman, alcoholic presented with duodenal obstruction for 3days. CECTabdomen was suggestive of exophytic lesion from second part of duodenum ?duodenal diverticulum. UGIE showed large growth with overlying abnormal mucosa causing luminal compromise in second part of duodenum. Biopsy was taken which showed normal villous pattern. Patient was managed conservatively and improved gradually. On further evaluation, EUS showed 5×5.5cm cystic space occupying lesion in close relation to second part of duodenum and head of pancreas ?origin. EUS guided FNAC showed features suggestive of adenocarcinoma. With this pathological diagnosis, patient was taken up for Whipple's procedure, intraoperatively, 3cm mass lesion was noted in the pancreaticoduodenal groove. HPE of the specimen showed a haemorraghic nodule (3×1.8×1.2cm) in the duodenal wall and changes of chronic pancreatitis in the pancreticoduodenal groove suggestive of GP. Postoperative period and follow up of 6 months was uneventful. DISCUSSION: In GP, EUS guided FNAC may reveal large gaint cells, spindle cells or hyperplasia of brunner glands depending on the area of sampling and these features mimic neoplasia as observed in our case. MRI criteria given by Kalb et al show diagnostic accuracy of 87.2% for GP and negative predictive value of 92.9% to rule out pancreatic cancer. Arvanitakis et al showed stepwise management approach is effective in GP and with combination of medical and endoscopic treatment, complete clinical response rate was observed in 80%. CONCLUSION: It is important to diagnose and differentiate GP from pancreatic cancer preoperatively and avoid morbidity from unnecessary pancreaticoduodenectomy in patients of GP.

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