Duodenum-preserving pancreatic head resections for surgical treatment of paraduodenal pancreatitis

Introduction. Up to date, no consensus exists on the surgical treatment of paraduodenal pancreatitis (PDP). Most authors prefer to perform pancreaticoduodenectomy when surgical treatment is indicated. However, such an aggressive approach may not always be justified for the treatment of benign disease. The aim of our study was to investigate the results of duodenum-preserving pancreatic head resections (DPPHR) for the treatment of PDP. Materials and methods. We performed a retrospective analysis of a database consisting of 112 patients with PDP treated in Shalimov National Institute of Surgery and Transplantology from 2014 to 2019. A total of 45 patients after DPPHR were included to the study. Such modifications of DPPHR as Frey’s, Beger’s and Berne’s procedures were used. The primary study endpoint was pain control assessed according to the Izbicki pain score before surgery and at follow-up visits. Secondary endpoints were defined as complication rate (Clavien — Dindo >2), hospital length of stay and 90-day mortality. All patients were followed-up for the assessment of pain cessation with a median of 33 months (range 8–54 months). Results. There were 42 males (93.3%) and 3 females (6.7%) in the study group. Preoperative Izbicki pain score result was 52.6 points. Follow-up pain score results were significantly lower at 11.7 points. Postoperative complication rate (Clavien — Dindo >2) was measured at 8.9%. Median hospital length of stay was 17.4 days. No mortality was recorded in the study group. All results were statistically significant (p<0.05). Conclusion. Application of DPPHR for the surgical treatment of PDP allows to achieve excellent results in terms of pain control (52.6 and 11.7 points on the Izbicki pain score before surgical intervention and at follow-up), while maintaining low complication (8.9%) and mortality (0%) rates.

Pancreatoduodenectomy for paraduodenal pancreatitis: a diagnostic and therapeutic challenge

Paraduodenal pancreatitis (PP) is a rare type of focal pancreatitis involving the groove space. It mimics pancreatic head carcinoma, and its diagnosis and treatment are challenging. Pancreatoduodenectomy (PD) has traditionally been the primary surgical treatment for duodenal stenosis or suspected cancer. We herein report a case of PP in a 65-year-old man. The patient was admitted to the hospital for postprandial epigastric pain and vomiting. A low-density mass between the uncinate process of the pancreas and the horizontal segment of the duodenum was suspected based on computed tomography findings. Both upper gastrointestinal radiography and gastrointestinal endoscopy showed an obstruction of the distal part of the descending duodenum. An operation was performed to release the obstruction and obtain a definitive diagnosis. A 3-cm mass in the groove area was compressing the third part of the duodenum, and PD was empirically performed. The final histopathological diagnosis was PP. Postoperatively, the patient developed anastomotic leakage of the gastrojejunostomy site with bleeding and was eventually discharged on postoperative day 51 after emergency surgery. PP should be considered as a differential diagnosis of pancreatic ductal adenocarcinoma or duodenal stenosis, and accurate preoperative diagnosis preserves the opportunity for conservative or endoscopic management.