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Agarwal L, Rathore KS, Varshney VK, Soni S, Selvakumar B, Varshney P, Agarwal A, Verma V, Sureka B, Yadav T. Surgical Management of Groove Pancreatitis: Lessons Learnt and Long-Term Experience. Dig Dis Sci 2025:10.1007/s10620-025-09025-8. [PMID: 40205281 DOI: 10.1007/s10620-025-09025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 03/27/2025] [Indexed: 04/11/2025]
Abstract
BACKGROUND Groove pancreatitis (GP) is a rare form of focal chronic pancreatitis characterized by inflammation in the anatomic space between the duodenal wall and the head of the pancreas. This study aims to review the surgical experience in diagnosing and managing GP at a tertiary healthcare center in India. METHODS A single-center, retrospective, cross-sectional study was conducted at the All India Institute of Medical Sciences, Jodhpur, between January 2017 and December 2023. The study included all patients with clinical, radiologic, and pathologic confirmation of GP. Data on demographics, clinical history, radiologic imaging, surgical intervention, and perioperative outcomes were collected. Pain and quality of life (QOL) were assessed preoperatively and postoperatively at 3, 6, and 12 months using the Izbicki pain score and the SF-36 questionnaire. RESULTS During the study period, eleven patients with a clinico-radiologic diagnosis of GP underwent surgery. The median diagnostic delay was 14 months. Common presenting symptoms included abdominal pain (100%), gastric outlet obstruction (81.8%), and obstructive jaundice (18.2%). The majority of patients had a history of tobacco and alcohol abuse. Pancreato-duodenectomy (PD) was performed in ten cases, while one patient underwent a bypass procedure. Post-operative complications included post-operative pancreatic fistula (27.3%), delayed gastric emptying (54.5%), and post-pancreatectomy hemorrhage (9.1%). Three patients developed Clavien-Dindo IIIa complications. The median follow-up duration was 19 (IQR: 12-22) months. At the 12-month follow-up, pain and QOL scores showed significant improvement across all domains when compared to pre-operative measurements (p < 0.001). Three patients had recurrent pancreatitis due to resumption of alcohol and tobacco use. CONCLUSION GP is a rare and complex condition with significant challenges in diagnosis and management. Surgical treatment, particularly PD, provides effective symptom relief and improves QOL in most patients.
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Affiliation(s)
- Lokesh Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Kaushal Singh Rathore
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - Subhash Soni
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - B Selvakumar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Peeyush Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Ayushi Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vikrant Verma
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
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Amodio A, de Pretis N, De Marchi G, Campagnola P, Crucillà S, Caldart F, Frulloni L. Management of acute pancreatitis in the "no man's land". Intern Emerg Med 2025:10.1007/s11739-025-03916-4. [PMID: 40188404 DOI: 10.1007/s11739-025-03916-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 03/03/2025] [Indexed: 04/08/2025]
Abstract
Acute pancreatitis (AP) is an inflammatory disease that can represent a challenge for clinicians, in fact, the early determination of its severity in the first 72 h is crucial for prognosis, recognizing the etiology and carrying out risk stratification to determine a more specific therapy. No accurate early prognostic scores for disease severity have been published, so the severity of AP often cannot be properly defined in the first few hours of the disease. This initial phase represents a "no man's land", in which there is no certainty in the stratification of the damage, prognosis is difficult to establish, therapy must be started promptly, although there is still no effective medical therapy against pancreatic enzymatic activation. Therefore, it is very difficult at this stage to make the correct decisions to achieve the best outcome for the patient with AP. Literature search was carried out using the PubMed database by entering early management of acute pancreatitis [title] or therapy of acute pancreatitis [title] and selecting the most relevant articles for the diagnosis and therapy of acute pancreatitis in clinical practice. This document provides suggestions on managing the key clinical decisions for patients suffering from AP before disease severity is defined, to achieve the best outcomes for patients with AP.
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Thomas A, Dev AV, John A, John RA, Patel L, Kurien RT, Eapen A, Simon EG, Dutta AK, Jaleel R, Joseph Joseph A, Chowdhury SD. The effectiveness of a conservative approach in the management of groove pancreatitis. Indian J Gastroenterol 2025:10.1007/s12664-024-01715-x. [PMID: 39826079 DOI: 10.1007/s12664-024-01715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 11/17/2024] [Indexed: 01/20/2025]
Abstract
BACKGROUND Groove pancreatitis (GP) is a form of pancreatitis that affects the pancreaticoduodenal groove area, which lies between the head of the pancreas, the second part of the duodenum and the distal bile duct, presenting as abdominal pain and gastric outlet obstruction. In this study, we present the clinical and radiological characteristics of individuals diagnosed with groove pancreatitis at our center and discuss the use of a conservative treatment approach in managing GP. METHODS The data of patients with groove pancreatitis treated at our center between January 2012 and December 2021 was analyzed. The clinical, laboratory and radiological features were recorded and patients were followed up for at least six months in the pancreatic clinic by a specialist doctor. RESULTS Fifty patients were included in the study. Most patients were males (98%) in the middle age group (35 to 55 years) (70%) with chronic alcohol use and/or smoking noted in 48 (96%) of them. Ninety-six per cent presented with recurrent abdominal pain. The most common imaging features were the thickening of the medial duodenal wall (100%) followed by enhancement of the scar tissue in the groove (98%). All patients were initially treated conservatively with advice to abstain from addictions, of whom 35 patients were followed up. Twenty per cent of the patients (seven out of 35) did not respond and required a step-up approach with endoscopic retrograde cholangiopancreatography (for biliary obstruction), celiac block (for ongoing abdominal pain) and surgery (gastrojejunostomy for gastric outlet obstruction, Frey's procedure for abdominal pain). Most patients were asymptomatic at follow-up (mean follow-up of 30 months). CONCLUSION The diagnosis of GP continues to be a challenge. A step-up approach appears to be a reasonable strategy in managing GP as most of them can be managed conservatively.
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Affiliation(s)
- Ajith Thomas
- Department of Gastroenterology, Christian Medical College, Vellore, 632 517, India
| | - Anand Vimal Dev
- Department of Gastroenterology, Christian Medical College, Vellore, 632 517, India
| | - Anoop John
- Department of Gastroenterology, Christian Medical College, Vellore, 632 517, India
| | - Reetu Amrita John
- Department of Radiology, Christian Medical College, Vellore, 632 004, India
| | - Lalji Patel
- Department of Gastroenterology, Christian Medical College, Vellore, 632 517, India
| | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Vellore, 632 517, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, 632 004, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Vellore, 632 517, India
| | - Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Vellore, 632 517, India
| | - Rajeeb Jaleel
- Department of Gastroenterology, Christian Medical College, Vellore, 632 517, India
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Dahiya DS, Shah YR, Canakis A, Parikh C, Chandan S, Ali H, Gangwani MK, Pinnam BSM, Singh S, Sohail AH, Patel R, Ramai D, Al-Haddad M, Baron T, Rastogi A. Groove pancreatitis: From enigma to future directions-A comprehensive review. J Gastroenterol Hepatol 2024; 39:2260-2271. [PMID: 39004833 DOI: 10.1111/jgh.16683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/23/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
Groove pancreatitis (GP) is a rare and clinically distinct form of chronic pancreatitis affecting the pancreaticoduodenal groove comprising the head of the pancreas, duodenum, and the common bile duct. It is more prevalent in individuals in their 4-5th decade of life and disproportionately affects men compared with women. Excessive alcohol consumption, tobacco smoking, pancreatic ductal stones, pancreatic divisum, annular pancreas, ectopic pancreas, duodenal wall thickening, and peptic ulcers are significant risk factors implicated in the development of GP. The usual presenting symptoms include severe abdominal pain, nausea, vomiting, diarrhea, weight loss, and jaundice. Establishing a diagnosis of GP is often challenging due to significant clinical and radiological overlap with numerous benign and malignant conditions affecting the same anatomical location. This can lead to a delay in initiation of treatment leading to increasing morbidity, mortality, and complication rates. Promising research in artificial intelligence (AI) has garnered immense interest in recent years. Due to its widespread application in diagnostic imaging with a high degree of sensitivity and specificity, AI has the potential of becoming a vital tool in differentiating GP from pancreatic malignancies, thereby preventing a missed or delayed diagnosis. In this article, we provide a comprehensive review of GP, covering the etiology, pathogenesis, clinical presentation, radiological and endoscopic evaluation, management strategies, and future directions. This article also aims to increase awareness about this lesser known and often-misdiagnosed clinical entity amongst clinicians to ultimately improve patient outcomes.
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Affiliation(s)
- Dushyant S Dahiya
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Yash R Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, Michigan, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Charmy Parikh
- Department of Internal Medicine, Carle BroMenn Medical Center, Normal, Illinois, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Hassam Ali
- Division of Gastroenterology, Hepatology and Nutrition, East Carolina University/Brody School of Medicine, Greenville, North Carolina, USA
| | - Manesh K Gangwani
- Department of Gastroenterology and Hepatology, University of Arkansas For Medical Sciences, Little Rock, Arkansas, USA
| | - Bhanu S M Pinnam
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Sahib Singh
- Department of Internal Medicine, Sinai Hospital, Baltimore, Maryland, USA
| | - Amir H Sohail
- Complex Surgical Oncology, Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Raj Patel
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daryl Ramai
- Department of Internal Medicine, St. Mary's Medical Center, Langhorne, Pennsylvania, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Todd Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, Kansas, USA
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Baydarova MD, Kiseleva YV, Tupikin KA, Kozlov IA, Zharikova TS, Pontes-Silva A, Zharikov YO. Duodenum-preserving total pancreatoduodenectomy with segmental duodenectomy vs pylorus-preserving pancreaticoduodenectomy for chronic pancreatitis with duodenal dystrophy: Retrospective study. Curr Probl Surg 2024; 61:101588. [PMID: 39266130 DOI: 10.1016/j.cpsurg.2024.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/13/2024]
Affiliation(s)
- Marina D Baydarova
- Department of Interventional Endoscopy, National Medical Research Center of Surgery named after A.V. Vishnevsky, Moscow, Russia.
| | - Yana V Kiseleva
- International School "Medicine of the Future," I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Kirill A Tupikin
- Laboratory of Minimally Invasive Surgery, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
| | - Ilya A Kozlov
- Federal State Healthcare Institution "Medical and sanitary unit of the Ministry of internal affairs of the Russian Federation in Moscow," Moscow, Russia.
| | - Tatyana S Zharikova
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - André Pontes-Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos São Paulo, Brazil.
| | - Yury O Zharikov
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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Bustos-Merlo A, Rosales-Castillo A, Alarcón-Blanco PA. [Groove pancreatitis: case of report]. Med Clin (Barc) 2024; 163:311-312. [PMID: 38839446 DOI: 10.1016/j.medcli.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Antonio Bustos-Merlo
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, España.
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Chen G, Sha Y, Chen L, Wang D, Tang R. The Hidden Agony of the Pancreas: A Comprehensive Case Study of Paraduodenal Pancreatitis. Cureus 2024; 16:e63149. [PMID: 39055407 PMCID: PMC11272387 DOI: 10.7759/cureus.63149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/26/2024] Open
Abstract
Paraduodenal pancreatitis (PP), also known as groove pancreatitis (GP), is a rare and distinct variant of chronic pancreatitis and presents significant diagnostic and therapeutic challenges. This comprehensive case study explores a 54-year-old male patient's journey, highlighting the intricate relationship between clinical presentation, diagnostic modalities, and management strategies. Despite a history of smoking and alcohol consumption, the diagnosis of PP was primarily reliant on advanced imaging techniques, including computed tomography and magnetic resonance imaging, which revealed characteristic findings of GP. The case underscores the importance of a high index of suspicion and a step-up approach to management, starting with conservative treatment and progressing to surgical intervention as necessary. This study contributes to the growing body of knowledge on PP, emphasizing the need for awareness and understanding of this rare condition to improve patient outcomes.
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Affiliation(s)
- Guangbin Chen
- Department of Hepatobiliary Surgery, The Second People's Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, CHN
- Graduate School, Wannan Medical College, Wuhu, CHN
| | - Yanguang Sha
- Graduate School, Wannan Medical College, Wuhu, CHN
- Department of Hepatobiliary Surgery, The Second People's Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, CHN
| | - Lifang Chen
- Department of Medical Imaging, The Second People's Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, CHN
| | - Dingbang Wang
- Department of Hepatobiliary Surgery, The Second People's Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, CHN
| | - Rongmei Tang
- Department of Hepatobiliary Surgery, The Second People's Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, CHN
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Breaza GM, Dan RG, Hut FE, Baderca F, Cretu OM, Sima LV. Pancreaticoduodenectomy with Anatomical Vascular Variant in Groove Pancreatitis-A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:626. [PMID: 38674272 PMCID: PMC11052064 DOI: 10.3390/medicina60040626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Groove pancreatitis represents a chronic focal form of pancreatitis affecting the zone between the pancreatic head and the duodenal "C" loop, known as the groove area. This is a rare condition that affects the pancreatic periampullary part, including the duodenum and the common bile duct, which is usually associated with long-term alcohol and tobacco misuse, and is more frequent in men than in women. The most common clinical symptoms of groove pancreatitis include weight loss, acute abdominal pain, nausea, and jaundice. This report is about a 66-year-old woman with a history of heavy smoking, presenting with weight loss, nausea, and upper abdominal pain. Contrast-enhanced computed tomography revealed the existence of chronic pancreatitis as well as the dilatation of the main pancreatic duct, a cyst of the pancreatic head, and enlargement of the biliary tract. Conservatory treatment was initiated but with no improvement of symptoms. Since endoscopic retrograde cholangiopancreatography was not possible due to the local changes, we decided to perform pancreatoduodenectomy, as surgery appears to be the single effective treatment.
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Affiliation(s)
- Gelu M. Breaza
- Department of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.M.B.); (F.E.H.); (O.M.C.); (L.V.S.)
| | - Radu G. Dan
- Department of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.M.B.); (F.E.H.); (O.M.C.); (L.V.S.)
| | - Florin E. Hut
- Department of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.M.B.); (F.E.H.); (O.M.C.); (L.V.S.)
| | - Flavia Baderca
- Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Octavian M. Cretu
- Department of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.M.B.); (F.E.H.); (O.M.C.); (L.V.S.)
| | - Laurentiu V. Sima
- Department of Surgery I, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.M.B.); (F.E.H.); (O.M.C.); (L.V.S.)
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Ebrahim MA, Zaher EA, Patel P, Alvi MS, Khanal S. Unraveling the Narrow Alley: A Case Report of Groove Pancreatitis. Cureus 2024; 16:e57683. [PMID: 38707162 PMCID: PMC11070197 DOI: 10.7759/cureus.57683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Groove pancreatitis, a rare subtype of chronic pancreatitis, predominantly affects middle-aged men with a history of alcohol abuse. We present a unique case of a 31-year-old female with minimal alcohol consumption. Imaging revealed characteristic findings consistent with groove pancreatitis. Despite its rarity in young females, clinical suspicion led to the appropriate diagnosis and conservative management, resulting in symptomatic resolution. This case underscores the importance of recognizing atypical presentations of groove pancreatitis, emphasizing the necessity of tailored diagnostic approaches, and highlighting the efficacy of conservative management in achieving favorable outcomes, particularly in non-typical demographics.
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Affiliation(s)
| | - Eli A Zaher
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Parth Patel
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | | | - Shreyashi Khanal
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
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She YM, Ge N. Diagnostic value of endoscopic ultrasound in groove pancreatitis. Ann Med 2023; 55:2295991. [PMID: 38134890 PMCID: PMC10763902 DOI: 10.1080/07853890.2023.2295991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Aim: Groove pancreatitis (GP) is a rare type of chronic pancreatitis characterized by varying degrees of thickening and scarring of the duodenal wall, duodenal lumen stenosis, mucosal hypertrophy with plicae and cyst formation. GP is primarily observed in middle-aged male patients with a history of alcohol consumption. Clinical symptoms are usually non-specific, and there is currently no unified diagnostic standard. However, imaging methods, particularly endoscopic ultrasound (EUS), are useful for diagnosis. EUS-guided biopsy can provide a strong basis for the final diagnosis. This review summarizes the value of EUS and its derivative technologies in the diagnosis, differential diagnosis and treatment of GP.Methods: After searching in PubMed and Web of Science databases using 'groove pancreatitis (GP)' and 'endoscopic ultrasonography (EUS)' as keywords, studies related were compiled and examined.Results: EUS and its derivative technologies are of great significance in the diagnosis, differential diagnosis, and treatment of GP, but there are still limitations that need to be comprehensively applied with other diagnostic methods to obtain the most accurate results.Conclusion: EUS has unique value in both the diagnosis and treatment of GP. Clinicians need to be well-versed in the advantages and limitations of EUS for GP diagnosis to select the most suitable imaging diagnostic method for different cases and to reduce the unnecessary waste of medical resources.
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Affiliation(s)
- Yu Mo She
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
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Ukegjini K, Steffen T, Tarantino I, Jonas JP, Rössler F, Petrowsky H, Gubler C, Müller PC, Oberkofler CE. Systematic review on groove pancreatitis: management of a rare disease. BJS Open 2023; 7:zrad094. [PMID: 37749756 PMCID: PMC10519812 DOI: 10.1093/bjsopen/zrad094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Groove pancreatitis is a focal form of chronic pancreatitis affecting the area of the paraduodenal groove. The aim of this systematic review was to assess the clinical presentation, diagnosis and treatment of patients with groove pancreatitis. METHODS Medical literature databases (Embase, Medline via PubMed and Cochrane Central Register of Controlled Trials) were systematically searched for data recorded between 1 January 1990 and 31 August 2022 regarding patient characteristics, diagnosis, surgical treatment and outcomes. The following inclusion criteria were applied: RCTs, observational studies (cohort and case-control studies) and case studies with >3 cases including patients with groove pancreatitis undergoing medical, endoscopic or surgical treatment with available clinical and diagnostic data. Fisher's exact test for binary data and Mann-Whitney U test or Student t-test for continuous data were adopted for statistical analysis. RESULTS Of 649 studies, 44 were included, involving reports on 1404 patients with a mean age of 49 years. In 41 of the 44 studies in which patient gender was described, 86 per cent (N = 1023) of patients were male. Information on the risk factors of alcohol and nicotine was available in 37 and 23 studies, respectively. Seventy-nine per cent (N = 886) of patients had a history of excessive alcohol consumption and 83 per cent (N = 595) were smokers. Information on clinical symptoms was available in 37 of the 44 included studies and 78.5 per cent (N = 870) presented with abdominal pain. Some 27 studies comprising 920 groove pancreatitis patients were treatment oriented. Seventy-four per cent (N = 682) of patients were treated conservatively, 26.4 per cent (N = 134) underwent endoscopic treatment and 54.7 per cent (N = 503) required surgery. There was complete relief of symptoms in 35.6 per cent (N = 243) after conservative treatment, 55.2 per cent (N = 74) after endoscopic treatment and 69.6 per cent (N = 350) after surgical treatment. The median follow-up time was 42 months (range, 1-161 months). CONCLUSION Groove pancreatitis shows on imaging a typical triad: cystic lesions in the pancreatic duct or duodenal wall, calcifications, and thickenings of the duodenal wall. Surgery appears to be the most effective treatment modality.
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Affiliation(s)
- Kristjan Ukegjini
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Thomas Steffen
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Ignazio Tarantino
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan P Jonas
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
| | - Fabian Rössler
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
| | - Christoph Gubler
- Department of Gastroenterology and Hepatology, Stadtspital Zürich, Zurich, Switzerland
| | - Philip C Müller
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Surgery, Clarunis—University Centre for Gastrointestinal and Hepatopancreatobiliary Diseases, Basel, Switzerland
| | - Christian E Oberkofler
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
- Vivévis AG—Visceral, Tumor and Robotic Surgery, Clinic Hirslanden Zurich, Zurich, Switzerland
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Valentini G, Surace M, Grosso S, Vernetto A, Serra AM, Andria I, Mazzucco D. Groove pancreatitis. Minerva Gastroenterol (Torino) 2023; 69:436-438. [PMID: 32677417 DOI: 10.23736/s2724-5985.20.02721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
| | - Monica Surace
- Unit of Gastroenterology, Rivoli Hospital, Turin, Italy
| | - Silvia Grosso
- Unit of Gastroenterology, Rivoli Hospital, Turin, Italy
| | | | - Anna M Serra
- Unit of Gastroenterology, Rivoli Hospital, Turin, Italy
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Usenko O, Khomiak I, Khomiak A, Malik A, Kropelnytskyi V, Krol M. Duodenum-preserving pancreatic head resection or pancreatoduodenectomy for the surgical treatment of paraduodenal pancreatitis: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:178. [PMID: 37140631 DOI: 10.1007/s00423-023-02917-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Paraduodenal pancreatitis (PDP) is an uncommon yet well-described type of focal chronic pancreatitis. The aim of our study was to compare the outcomes of surgical treatment of patients with PDP using pancreatoduodenectomy and duodenum-preserving pancreatic head resection (DPPHR). METHODS A retrospective analysis of 153 consecutive patients with PDP was performed. Patients who were treated with either DPPHR or PD were enrolled. The primary endpoint of the study was pain control achieved at the time of follow-up. The secondary endpoints of the study were complication rate (Clavien-Dindo > 2), hospital length of stay, and 90-day mortality. All patients were followed up after discharge for the assessment of pain cessation for a minimal period of 10 months. RESULTS The final study population consisted of 71 patients. A total of 14 patients (19.7%) underwent pancreatoduodenectomy, and 57 (80.3%) were managed with DPPHR. Complication rate was significantly lower in DPPHR group at χ2 = 4.2677, p < 0.05. Mean hospital length of stay was 9.3 days (range 3-29) in DPPHR group and 13.9 days (range 7-35) in PD group (p < 0.05). No postoperative mortality was recorded. The mean follow-up period of the patients after surgery was 41.8 ± 20.6 months (range 10-88). Pain scores at the time of operation were calculated as 50.9 ± 12.1 in DPPHR group and 56.1 ± 11.4 in PD group. At the time of follow-up, pain scores improved significantly in both groups and were 10.3 ± 8.8 and 10.9 ± 8.6, respectively. CONCLUSION DPPHR achieves similar results in pain control as PD with a lower complication rate and shorter hospital LOS.
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Affiliation(s)
- Oleksandr Usenko
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Igor Khomiak
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Andrii Khomiak
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO, 80045, USA.
| | - Andrii Malik
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Vladislav Kropelnytskyi
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Mark Krol
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
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Ioannidis A, Menni A, Tzikos G, Ioannidou E, Makri G, Vouchara A, Goulas P, Karlafti E, Psoma E, Mavropoulou X, Paramythiotis D. Surgical Management of Groove Pancreatitis: A Case Report. J Pers Med 2023; 13:644. [DOI: https:/doi.org/10.3390/jpm13040644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2025] Open
Abstract
Groove pancreatitis (GP) is a chronic type of pancreatitis involving the groove area between the head of the pancreas, the duodenum, and the common bile duct. Alcohol abuse is one of the main pathogenetic factors, although its etiology is not clearly defined. Differential diagnosis of pancreatic disorders remains difficult. The lack of diagnostic management and the restrictive number of patients are the main barriers. This article presents a case of a 37-year-old male diagnosed with GP after several episodes of epigastric pain and vomiting, with a history of chronic alcohol consumption. The patient’s radiological and laboratory results excluded the possibility of malignancy and suggested the diagnosis of groove pancreatitis with duodenal stenosis. After initial conservative treatment failed, surgical management was decided. A gastroenteroanastomosis was made in order to bypass the duodenum aiming for a total resolution of the symptoms and an uneventful recovery of the patient. Although most studies suggest pancreatoduodenectomy (Whipple’s procedure) as the treatment of choice, a less major procedure can be performed in evidence of malignancy absence.
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Affiliation(s)
- Aristeidis Ioannidis
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Alexandra Menni
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Georgios Tzikos
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Eleni Ioannidou
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Georgia Makri
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Angeliki Vouchara
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Patroklos Goulas
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Eleni Karlafti
- Emergency Department, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Elizabeth Psoma
- Department of Radiology, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Xanthipi Mavropoulou
- Department of Radiology, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
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15
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Ioannidis A, Menni A, Tzikos G, Ioannidou E, Makri G, Vouchara A, Goulas P, Karlafti E, Psoma E, Mavropoulou X, Paramythiotis D. Surgical Management of Groove Pancreatitis: A Case Report. J Pers Med 2023; 13:644. [PMID: 37109030 PMCID: PMC10146020 DOI: 10.3390/jpm13040644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/23/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Groove pancreatitis (GP) is a chronic type of pancreatitis involving the groove area between the head of the pancreas, the duodenum, and the common bile duct. Alcohol abuse is one of the main pathogenetic factors, although its etiology is not clearly defined. Differential diagnosis of pancreatic disorders remains difficult. The lack of diagnostic management and the restrictive number of patients are the main barriers. This article presents a case of a 37-year-old male diagnosed with GP after several episodes of epigastric pain and vomiting, with a history of chronic alcohol consumption. The patient's radiological and laboratory results excluded the possibility of malignancy and suggested the diagnosis of groove pancreatitis with duodenal stenosis. After initial conservative treatment failed, surgical management was decided. A gastroenteroanastomosis was made in order to bypass the duodenum aiming for a total resolution of the symptoms and an uneventful recovery of the patient. Although most studies suggest pancreatoduodenectomy (Whipple's procedure) as the treatment of choice, a less major procedure can be performed in evidence of malignancy absence.
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Affiliation(s)
- Aristeidis Ioannidis
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Alexandra Menni
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Georgios Tzikos
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Eleni Ioannidou
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Georgia Makri
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Angeliki Vouchara
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Patroklos Goulas
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Eleni Karlafti
- Emergency Department, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Elizabeth Psoma
- Department of Radiology, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Xanthipi Mavropoulou
- Department of Radiology, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Department of Surgery, Aristotle’s University of Thessaloniki, AHEPA University Hospital, 54634 Thessaloniki, Greece
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16
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de Ponthaud C, Daire E, Pioche M, Napoléon B, Fillon M, Sauvanet A, Gaujoux S. Cystic dystrophy in heterotopic pancreas. J Visc Surg 2023; 160:108-117. [PMID: 36966112 DOI: 10.1016/j.jviscsurg.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare and complicated presentation involving heterotopic pancreatic tissue in the duodenal wall. This condition is present in 5% of the general population but disease mainly affects middle-aged alcoholic-smoking men with chronic pancreatitis (CP). It may be purely duodenal or segmental (pancreatico-duodenopathy). Its pathophysiology arises from alcohol toxicity with obstruction of small ducts of heterotopic pancreatic tissue present in the duodenal wall and the pancreatic-duodenal sulcus, leading to repeated episodes of pancreatitis. The symptomatology includes episodes of acute pancreatitis, weight loss, and vomiting due to duodenal obstruction. Imaging shows thickening of the wall of the second portion of the duodenum with multiple small cysts. A stepwise therapeutic approach is preferred. Conservative medical treatment is favored in first intention (analgesics, continuous enteral feeding, somatostatin analogues), which allows complete symptomatic regression in 57% of cases associated with a 5% rate of complications (arterial thrombosis and diabetes). Endoscopic treatment may also be associated with conservative measures. Surgery achieves a complete regression of symptoms in 79% of cases but with a 20% rate of complications. Surgery is indicated in case of therapeutic failure or in case of doubt about a malignant tumor. Pancreaticoduodenectomy and duodenal resection with pancreatic preservation (PPDR) seem to be the most effective treatments. PPDR has also been proposed as a first-line treatment for purely duodenal location of paraduodenal pancreatitis, thereby preventing progression to an extended segmental form.
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Affiliation(s)
- C de Ponthaud
- Department of hepatobiliary and pancreatic surgery and liver transplantation, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Department of general, visceral and endocrine surgery, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Sorbonne university, Paris, France
| | - E Daire
- Gastroenterology department, Édouard-Herriot hospital, Lyon, France
| | - M Pioche
- Gastroenterology department, Édouard-Herriot hospital, Lyon, France
| | - B Napoléon
- Gastroenterology department, Jean Mermoz hospital, Lyon, France
| | - M Fillon
- Radiology department, la Croix Rousse hospital, Lyon, France
| | - A Sauvanet
- Pancreatic and hepatobiliary surgery department, Beaujon hospital, AP-HP, Clichy, France; University of Paris, France
| | - S Gaujoux
- Department of hepatobiliary and pancreatic surgery and liver transplantation, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Department of general, visceral and endocrine surgery, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Sorbonne university, Paris, France.
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17
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Bonatti M, De Pretis N, Zamboni GA, Brillo A, Crinò SF, Valletta R, Lombardo F, Mansueto G, Frulloni L. Imaging of paraduodenal pancreatitis: A systematic review. World J Radiol 2023; 15:42-55. [PMID: 36874260 PMCID: PMC9979191 DOI: 10.4329/wjr.v15.i2.42] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/24/2022] [Accepted: 12/06/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Paraduodenal pancreatitis (PP) represents a diagnostic challenge, especially in non-referral centers, given its potential imaging overlap with pancreatic cancer. There are two main histological variants of PP, the cystic and the solid, with slightly different imaging appearances. Moreover, imaging findings in PP may change over time because of disease progression and/or as an effect of its risk factors exposition, namely alcohol intake and smoking.
AIM To describe multimodality imaging findings in patients affected by PP to help clinicians in the differential diagnosis with pancreatic cancer.
METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses 2009 guidelines. A Literature search was performed on PubMed, Embase and Cochrane Library using (groove pancreatitis [Title/Abstract]) OR (PP [Title/Abstract]) as key words. A total of 593 articles were considered for inclusion. After eliminating duplicates, and title and abstract screening, 53 full-text articles were assessed for eligibility. Eligibility criteria were: Original studies including 8 or more patients, fully written in English, describing imaging findings in PP, with pathological confirmation or clinical-radiological follow-up as the gold standard. Finally, 14 studies were included in our systematic review.
RESULTS Computed tomography (CT) findings were described in 292 patients, magnetic resonance imaging (MRI) findings in 231 and endoscopic ultrasound (EUS) findings in 115. Duodenal wall thickening was observed in 88.8% of the cases: Detection rate was 96.5% at EUS, 91.0% at MRI and 84.1% at CT. Second duodenal portion increased enhancement was recognizable in 76.3% of the cases: Detection rate was 84.4% at MRI and 72.1% at CT. Cysts within the duodenal wall were detected in 82.6% of the cases: Detection rate was 94.4% at EUS, 81.9% at MRI and 75.7% at CT. A solid mass in the groove region was described in 40.9% of the cases; in 78.3% of the cases, it showed patchy enhancement in the portal venous phase, and in 100% appeared iso/hyperintense during delayed phase imaging. Only 3.6% of the lesions showed restricted diffusion. The prevalence of radiological signs of chronic obstructive pancreatitis, namely main pancreatic duct dilatation, pancreatic calcifications, and pancreatic cysts, was extremely variable in the different articles.
CONCLUSION PP has peculiar imaging findings. MRI is the best radiological imaging modality for diagnosing PP, but EUS is more accurate than MRI in depicting duodenal wall alterations.
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Affiliation(s)
- Matteo Bonatti
- Department of Radiology, Ospedale Centrale di Bolzano, Bolzano 39100, Italy
| | - Nicolò De Pretis
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital of Verona, Verona 37134, Italy
| | - Giulia A Zamboni
- Department of Diagnostics and Public Health, Radiology Section, Policlinico GB Rossi, University of Verona, Verona 37134, Verona, Italy
| | - Alessandro Brillo
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital of Verona, Verona 37134, Italy
| | | | - Riccardo Valletta
- Department of Radiology, Ospedale Centrale di Bolzano, Bolzano 39100, Italy
| | - Fabio Lombardo
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar 37024, Italy
| | - Giancarlo Mansueto
- Department of Diagnostics and Public Health, Radiology Section, Policlinico GB Rossi, University of Verona, Verona 37134, Verona, Italy
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital of Verona, Verona 37134, Italy
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18
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Kutty SA, Chirukandath R, PJ B, C N, A AT. Groove Pancreatitis: A Case Report and Review of a Hidden Type of Chronic Pancreatitis. Cureus 2022; 14:e27738. [PMID: 36134063 PMCID: PMC9481208 DOI: 10.7759/cureus.27738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/11/2022] Open
Abstract
Groove pancreatitis is a chronic type of segmental or focal pancreatitis seen to affect the groove, which is the region between the head of the pancreas, the duodenum, and the common bile duct. Despite its incidence remaining unknown, it accounts for 2.7% to 24.5% of pancreaticoduodenectomies performed for chronic pancreatitis. A diverse etiology has been implicated but the exact cause is yet to be identified. As it closely mimics pancreatic malignancy and remains mostly undiagnosed preoperatively, many patients often end up undergoing a pancreaticoduodenectomy. Awareness of this entity and early diagnosis will help us address this issue with more conservative measures than by resorting to a morbid procedure such as a pancreaticoduodenectomy. We report a case of a 50-year-old male, a chronic alcoholic, with a two-year history of upper abdominal pain, postprandial vomiting, and weight loss. An abdominal contrast-enhanced computed tomography (CECT) scan was suggestive of either a pancreatic malignancy or a possibility of groove pancreatitis. However, postoperative histopathological examination confirmed the lesser known groove pancreatitis. Here, we review the clinical, radiological, and pathological characteristics of groove pancreatitis, as its diagnosis and management still pose a challenge.
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Teo J, Suthananthan A, Pereira R, Bettington M, Slater K. Could it be groove pancreatitis? A frequently misdiagnosed condition with a surgical solution. ANZ J Surg 2022; 92:2167-2173. [PMID: 35916436 PMCID: PMC9543432 DOI: 10.1111/ans.17939] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
Background Groove pancreatitis (GP) is an underrecognised subtype of chronic pancreatitis, focally affecting the area between the duodenum and pancreatic head. It most commonly affects males between 40 and 50 years of age with a history of alcohol misuse. Patients most commonly complain of abdominal pain and vomiting. Due to its focal nature, it is a potentially surgically treatable form of chronic pancreatitis. We report results of patients surgically treated for groove pancreatitis followed by a literature review of patient outcomes post resection. Methods A retrospective chart review of patients with histopathologically confirmed GP post‐surgical resection at the Princess Alexandra Hospital and Greenslopes Private Hospital in Brisbane, Australia was conducted between 2013 and 2020. Diagnosis was confirmed histologically when Brunner gland hyperplasia and chronic inflammation/fibrosis were found within the pancreaticoduodenal interface. Preoperative and postoperative symptoms were analysed along with complications. Additionally, a systematic review on outcomes of patients undergoing pancreaticoduodenectomy (PD) for GP was performed from three databases. Results Eight patients underwent surgery for GP. Elimination of preoperative symptoms was achieved in five of the eight patients. Major complications included one take back to theatre for pancreatic leak. Our literature review found complete resolution of pain and vomiting in 80% of GP patients after PD. Conclusion Optimal management of GP begins with early recognition. Symptoms from GP are likely to respond well to surgical intervention. We advocate for aggressive surgical resection in a patient with a high index of suspicion for GP.
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Affiliation(s)
- Joshua Teo
- Hepatopancreatobiliary Surgery Unit, Level 4, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Arul Suthananthan
- Hepatopancreatobiliary Surgery Unit, Level 4, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ryan Pereira
- Hepatopancreatobiliary Surgery Unit, Level 4, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Kellee Slater
- Hepatopancreatobiliary Surgery Unit, Level 4, The Princess Alexandra Hospital, Brisbane, Queensland, Australia.,General Surgery, Greenslopes Private Hospital, Brisbane, Queensland, Australia
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Dhali A, Ray S, Ghosh R, Misra D, Dhali GK. Outcome of Whipple's procedure for Groove pancreatitis: A retrospective cross-sectional study. Ann Med Surg (Lond) 2022; 79:104008. [PMID: 35860048 PMCID: PMC9289339 DOI: 10.1016/j.amsu.2022.104008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Groove pancreatitis (GP) is a rare form of chronic pancreatitis primarily affecting the pancreatoduodenal groove. Very few studies have been published from India. The aim of the present study is to report our experience with Whipple's procedure for GP. METHODOLOGY In this cross-sectional study, data of all patients who underwent Whipple's procedure for GP between August 2007 and July 2021 were retrospectively reviewed. RESULTS Of the total 504 Whipple's procedures, histopathologically proven GP was identified in 9 patients. All of them were male. Mean age at presentation was 42.66 ± 4.35 years. All of them had history of alcohol abuse. Eight (88.8%) of them had history of smoking. Postprandial abdominal discomfort and pain (n = 9, 100%) was the most common presenting symptom. Three (33.3%) patients had solid variety and six (66.6%) patients had cystic dystrophy of the duodenal wall. Two (22.2%) patients had mass in the head of the pancreas which was thought to be malignant. None of the patients underwent prior endoscopic management (stenting). Duration of surgery and blood loss was 330 (range, 300-379) minutes, and 250 (range, 200-750) ml respectively. There was no postoperative mortality. Postoperative complications developed in 5 (55.5%) patients. All the complications were managed conservatively. Median postoperative hospital stay was 10 (range, 9-16) days. Over a median follow-up of 41 (range, 12-120) months, complete remission of symptoms was achieved in 7 (78%) patients. CONCLUSION Whipple's procedure is safe with acceptable perioperative outcomes and good long-term symptom control.
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Affiliation(s)
- Arkadeep Dhali
- Department of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Sukanta Ray
- Department of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Ranajoy Ghosh
- Department of GI Pathology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Debashis Misra
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
| | - Gopal Krishna Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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21
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Vujasinovic M, Pozzi Mucelli R, Grigoriadis A, Palmér I, Asplund E, Rutkowski W, Baldaque-Silva F, Waldthaler A, Ghorbani P, Verbeke CS, Löhr JM. Paraduodenal pancreatitis - problem in the groove. Scand J Gastroenterol 2022; 57:726-733. [PMID: 35138983 DOI: 10.1080/00365521.2022.2036806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Paraduodenal pancreatitis (PDP) is a particular form of chronic pancreatitis (CP) occurring in and around the duodenal wall. Despite its low prevalence, this rare condition presents a significant challenge in clinical practice. METHODS We retrospectively analysed the electronic medical charts of all patients with a diagnosis of chronic pancreatitis and identified those with PDP, between January 1999 and December 2020. RESULTS There were 35 patients diagnosed with PDP (86% males and 14% females); median age of 56 ± 11 (range 38-80). Alcohol overconsumption was reported in 81% and smoking in 90% of patients. Abdominal pain was the leading symptom (71%), followed by weight loss, nausea and vomiting, jaundice, and diarrhoea. In 23 patients (66%), recurrent acute pancreatitis attacks were noted. Focal duodenal wall thickening was present in 34 patients (97%), cystic lesions in 80%, pancreatic duct dilatation in 54% and common bile duct dilatation in 46%. Endoscopic treatment was performed on nine patients (26%) and five patients (14%) underwent surgery. Complete symptom relief was reported in 12 patients (34%), partial symptom relief in three (9%), there was no improvement in five (14%), data were not available in three (9%) and 12 (34%) patients died before data analysis. CONCLUSIONS PDP is a rare form of pancreatitis, most commonly occurring in the 5th or 6th decade of life, with a predominance in males and patients with a history of smoking and high alcohol consumption. Focal thickening and cystic lesions of the duodenal wall are the most common imaging findings, followed by pancreatic duct and common bile duct dilatation. A minority of patients requires surgery.
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Affiliation(s)
- Miroslav Vujasinovic
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Raffaella Pozzi Mucelli
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Aristeidis Grigoriadis
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Isabella Palmér
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ebba Asplund
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Wiktor Rutkowski
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Francisco Baldaque-Silva
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Waldthaler
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Poya Ghorbani
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Caroline S Verbeke
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
- Department of Pathology, University of Oslo, Oslo, Norway
| | - J Matthias Löhr
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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22
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Kulkarni CB, Moorthy S, Pullara SK, Prabhu NK. CT imaging patterns of paraduodenal pancreatitis: a unique clinicoradiological entity. Clin Radiol 2022; 77:e613-e619. [PMID: 35589430 DOI: 10.1016/j.crad.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/14/2022] [Indexed: 12/19/2022]
Abstract
AIM To analyse the computed tomography (CT) findings of paraduodenal pancreatitis (PP) in patients treated at Amrita Institute of Medical Sciences. MATERIALS AND METHODS Clinical, laboratory, and CT findings of 30 patients with PP treated from July 2007 to December 2020 were reviewed retrospectively. RESULTS The average age of the patients was 45.9 years (19-60 years), which included 29 (96.7%) men, and 90% had a history of alcohol abuse. The majority [22 (73.3%)] presented with recurrent abdominal pain. Serum amylase was elevated in 21 (70%) patients and serum lipase was elevated in 25 (83.3%) patients. Carbohydrate antigen (CA 19-9) was elevated in three (10%) patients. The cystic pattern was seen in three (10%), solid pattern in 13 (43.3%), and solid-cystic pattern in 14 (46.7%) patients. The pure form of the disease was seen in seven (23.3%) patients, whereas the segmental form was seen in 23 (76.7%) patients. Descending duodenal wall thickening and enhancement was seen in 25 (83.3%) and 18 (60%) patients, respectively. The gastroduodenal artery was displaced medially in 12 (40%) patients and encased in five (16.7%) patients; however, it was not occluded in any of the patients. Calcifications were seen in the groove lesion in nine (30%) patients. The pancreas showed atrophic changes in 14 (46.6%) patients and calcifications in 12 (40%) patients. Distal common bile duct strictures were seen in three (10%) patients. CONCLUSIONS The presence of sheet-like soft-tissue thickening in the groove with diffuse duodenal thickening and intramural/paraduodenal cysts are highly suggestive of PP. Identifying characteristic imaging findings of PP may help in prospective diagnosis and lead to conservative management of most of these patients avoiding unnecessary invasive procedures.
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Affiliation(s)
- C B Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala state, India.
| | - S Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala state, India
| | - S K Pullara
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala state, India
| | - N K Prabhu
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala state, India
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LeCompte MT, Mason B, Robbins KJ, Yano M, Chatterjee D, Fields RC, Strasberg SM, Hawkins WG. Clinical classification of symptomatic heterotopic pancreas of the stomach and duodenum: A case series and systematic literature review. World J Gastroenterol 2022; 28:1455-1478. [PMID: 35582670 PMCID: PMC9048474 DOI: 10.3748/wjg.v28.i14.1455] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/11/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract. While the majority of heterotopic pancreatic lesions are asymptomatic, many manifest severe clinical symptoms which require surgical or endoscopic intervention. Understanding of the clinical manifestations and symptoms of HP is limited due to the lack of large volume studies in the literature. The purpose of this study is to review symptomatic cases at a single center and compare these to a systematic review of the literature in order to characterize common clinical manifestations and treatment of this disease.
AIM To classify the common clinical manifestations of heterotopic pancreas.
METHODS A retrospective review was conducted of pathologic samples containing heterotopic pancreas from 2000-2018. Review was limited to HP of the upper gastrointestinal tract due to the frequency of presentation in this location. Symptomatic patients were identified from review of the medical records and clinical symptoms were tabulated. These were compared to a systematic review of the literature utilizing PubMed and Embase searches for papers pertaining to heterotopic pancreas. Publications describing symptomatic presentation of HP were selected for review. Information including demographics, symptoms, presentation and treatment were compiled and analyzed.
RESULTS Twenty-nine patient were identified with HP at a single center, with six of these identified has having clinical symptoms. Clinical manifestations included, gastrointestinal bleeding, gastric ulceration with/without perforation, pancreatitis, and gastric outlet obstruction. Systemic review of the literature yielded 232 publications detailing symptomatic cases with only 20 studies describing ten or more patients. Single and multi-patient studies were combined to form a cohort of 934 symptomatic patients. The majority of patients presented with abdominal pain (67%) combined with one of the following clinical categories: (1) Dyspepsia, (n = 445, 48%); (2) Pancreatitis (n = 260, 28%); (3) Gastrointestinal bleeding (n = 80, 9%); and (4) Gastric outlet obstruction (n = 80, 9%). The majority of cases (n = 832, 90%) underwent surgical or endoscopic resection with 85% reporting resolution or improvement in their symptoms.
CONCLUSION Heterotopic pancreas can cause significant clinical symptoms in the upper gastrointestinal tract. Better understanding and classification of this disease may result in more accurate identification and treatment of this malformation.
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Affiliation(s)
- Michael T LeCompte
- Department of Surgical Oncology, University of North Carolina, Raleigh, NC 27608, United States
| | - Brandon Mason
- Department of Radiology, Stillwater Medical Center, Stillwater, OK 74074, United States
| | - Keenan J Robbins
- Department of General Surgery, Washington University St. Louis, St. Louis, MO 63110-8109, United States
| | - Motoyo Yano
- Department of Radiology, Mayo Clinic, Phoenix, AZ 8505, United States
| | - Deyali Chatterjee
- Department of Pathology and Immunology, MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Ryan C Fields
- Department of Surgical Oncology, Washington University School of Medicine, St. Louis, MO 63110-8109, United States
| | - Steven M Strasberg
- Section of Hepatobiliary-Pancreatic and GI Surgery, Washington University St. Louis, St. Louis, MO 63110, United States
| | - William G Hawkins
- Section of Hepatobiliary-Pancreatic and GI Surgery, Washington University St. Louis, St. Louis, MO 63110, United States
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24
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Diagnosis, natural course and treatment outcomes of groove pancreatitis. HPB (Oxford) 2021; 23:1244-1252. [PMID: 33483260 DOI: 10.1016/j.hpb.2020.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/21/2020] [Accepted: 12/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Groove pancreatitis (GP) is a rare form of chronic pancreatitis with limited data on its diagnostics and treatment outcomes. The aim of this study was to assess its diagnostics, natural course, and treatment options. METHODS The study is a retrospective population-based study from Southern Finland, including all patients with suspected GP between January 2005 and December 2015. Two certified gastrointestinal radiologists re-reviewed the imaging studies. The radiological re-review, clinical judgment, and final histopathology confirmed the GP diagnoses. RESULTS Out of 67 patients with possible GP, 39 patients were considered to have high radiological certainty of GP. Out of these 39, five patients had cancer instead. Thirty-three patients with confirmed GP formed the final study cohort. Patients with GP were mostly middle-aged (median 55 years) men. All had at least moderate alcohol consumption. No intervention was needed in 14 patients. In five-year follow-up all conservatively treated patients became asymptomatic, while 10 out of 16 patients undergoing at least one intervention were asymptomatic at five years. CONCLUSION The radiological diagnosis of GP is difficult, and a low threshold for cancer suspicion should be kept. Symptoms of GP decrease with time and suggest conservative treatment as the first-line option.
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Egorov V, Petrov R, Schegolev A, Dubova E, Vankovich A, Kondratyev E, Dobriakov A, Kalinin D, Schvetz N, Poputchikova E. Pancreas-preserving duodenal resections vs pancreatoduodenectomy for groove pancreatitis. Should we revisit treatment algorithm for groove pancreatitis? World J Gastrointest Surg 2021; 13:30-49. [PMID: 33552393 PMCID: PMC7830077 DOI: 10.4240/wjgs.v13.i1.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of cystic dystrophy of the duodenal wall (CDDW), or groove pancreatitis (GP), remains controversial. Although pancreatoduodenectomy (PD) is considered the most suitable operation for CDDW, pancreas-preserving duodenal resection (PPDR) has also been suggested as an alternative for the pure form of GP (isolated CDDW). There are no studies comparing PD and PPDR for this disease. AIM To compare the safety, efficacy, and short- and long-term results of PD and PPDR in patients with CDDW. METHODS A retrospective analysis of the clinical, radiologic, pathologic, and intra- and postoperative data of 84 patients with CDDW (2004-2020) and a comparison of the safety and efficacy of PD and PPDR. RESULTS Symptoms included abdominal pain (100%), weight loss (76%), vomiting (30%) and jaundice (18%) and data from computed tomography, magnetic resonance imaging, and endoUS led to the correct preoperative diagnosis in 98.8% of cases. Twelve patients were treated conservatively with pancreaticoenterostomy (n = 8), duodenum-preserving pancreatic head resection (n = 6), PD (n = 44) and PPDR (n = 15) without mortality. Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR (93%) and PD (84%) compared to the other treatment modalities (18%). New onset diabetes mellitus and severe exocrine insufficiency occurred after PD (31% and 14%), but not after PPDR. CONCLUSION PPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW. The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease. Early detection of CDDW provides an opportunity for pancreas-preserving surgery.
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Affiliation(s)
- Vyacheslav Egorov
- Department of Surgical Oncology, Ilyinskaya Hospital, Moscow 143421, Russia
| | - Roman Petrov
- Department of Surgical Oncology, Ilyinskaya Hospital, Moscow 143421, Russia
| | - Aleksandr Schegolev
- V. I. Kulakov Research Center for Obstetrics, Ministry Hlth Russian Federat, VI Kulakov Res Ctr Obstet Gynecol & Perinatol, Moscow 119526, Russia
| | - Elena Dubova
- Department of Pathology, Buranazian Federal Medical and Biological Center of the Federal Medical and Biological Agency of Russian Federation, Moscow 143421, Russia
| | - Andrey Vankovich
- Department of HPB Surgery, Moscow Clinical Research Center, Moscow 111123, Russia
| | - Eugeny Kondratyev
- Department of Radiology, Vishnevsky Institute of Surgery, Ilyinskaya Hospital, Moscow 143421, Russia
| | - Andrey Dobriakov
- Department of Pathology, Bakhrushin Brothers Moscow City Hospital, Moscow 107076, Russia
| | - Dmitry Kalinin
- Department of Pathology, Vishnevsky Institute of Surgery, Ilyinskaya Hospital, Moscow 117997, Russia
| | - Natalia Schvetz
- Department of Pathology, Bakhrushin Brothers Moscow City Hospital, Moscow 107076, Russia
| | - Elena Poputchikova
- Department of Pathology, Bakhrushin Brothers Moscow City Hospital, Moscow 107076, Russia
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26
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Luchini C, Fassan M, Doglioni C, Capelli P, Ingravallo G, Renzulli G, Pecori S, Paolino G, Florena AM, Scarpa A, Zamboni G. Inflammatory and tumor-like lesions of the pancreas. Pathologica 2020; 112:197-209. [PMID: 33179622 PMCID: PMC7931580 DOI: 10.32074/1591-951x-168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Inflammatory/tumor-like lesions of the pancreas represent a heterogeneous group of diseases that can variably involve the pancreatic gland determining different signs and symptoms. In the category of inflammatory/tumor-like lesions of the pancreas, the most important entities are represented by chronic pancreatitis, which includes alcoholic, obstructive and hereditary pancreatitis, paraduodenal (groove) pancreatitis, autoimmune pancreatitis, lymphoepithelial cyst, pancreatic hamartoma and intrapancreatic accessory spleen. An in-depth knowledge of such diseases is essential, since they can cause severe morbidity and may represent a potential life-threatening risk for patients. Furthermore, in some cases the differential diagnosis with malignant tumors may be challenging. Herein we provide a general overview of all these categories, with the specific aim of highlighting their most important clinic-pathological hallmarks to be used in routine diagnostic activities and clinical practice.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Italy
| | - Claudio Doglioni
- Vita e Salute University, Milan, Italy
- Pathology Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Capelli
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation, Section of Pathological Anatomy, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppina Renzulli
- Department of Emergency and Organ Transplantation, Section of Pathological Anatomy, University of Bari Aldo Moro, Bari, Italy
| | - Sara Pecori
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Gaetano Paolino
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Ada M. Florena
- Department of Sciences for Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
- ARC-NET Research Centre, University of Verona, Verona, Italy
| | - Giuseppe Zamboni
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
- IRCSS Sacro Cuore Don Calabria Hospital, Negrar, Italy
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Ismail IB, Zenaidi H, Yahmadi A, Rebii S, Zoghlami A. Surgical management of groove pancreatitis: a case report. Pan Afr Med J 2020; 36:99. [PMID: 32774658 PMCID: PMC7392864 DOI: 10.11604/pamj.2020.36.99.21873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/14/2020] [Indexed: 12/02/2022] Open
Abstract
Groove pancreatitis (GP) is a rare form of chronic pancreatitis involving the groove area bound by the pancreatic head, the duodenum, and the common bile duct. The diagnosis of this entity is challenging since it can mimic pancreatic carcinoma. We herein report the case of groove pancreatitis diagnosed in a 37 year old men, with a past history of chronic alcohol consumption. The patient was admitted for several times over the past three years because of recurrent alcohol-induced pancreatitis. The diagnosis of groove pancreatitis was made on the basis of CT, MRI and EUS findings. A medical treatment was initially attempted. In the absence of improvement in clinical symptoms, a pancreatico-duodenectomy was performed with satisfying results at 24 months follow up. Pancreatico-duodenectomy is the treatment of choice in groove pancreatitis since it leads to total resolution of clinical symptoms.
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Affiliation(s)
- Imen Ben Ismail
- Department of general surgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Hakim Zenaidi
- Department of general surgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Abdelwahed Yahmadi
- Department of general surgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Saber Rebii
- Department of general surgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Ayoub Zoghlami
- Department of general surgery, Trauma and Burns Center, Ben Arous, Tunisia
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28
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Patel BN, Brooke Jeffrey R, Olcott EW, Zaheer A. Groove pancreatitis: a clinical and imaging overview. Abdom Radiol (NY) 2020; 45:1439-1446. [PMID: 31559471 DOI: 10.1007/s00261-019-02239-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Groove or paraduodenal pancreatitis is an uncommon fibroinflammatory form of pancreatitis involving the anatomic space of the pancreatic groove located between the C-loop of the duodenum and the head of the pancreas. Although in some patients there are distinctive clinical and imaging features of groove pancreatitis (GP), there is often significant overlap with other infiltrative processes involving the pancreatic groove such as pancreatic ductal adenocarcinoma or duodenal carcinoma. In this review, we summarize the most distinctive clinical and imaging aspects of GP and highlight some important distinguishing features that may aid in differentiating malignant lesions involving the pancreatic groove.
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Affiliation(s)
- Bhavik N Patel
- Division of Abdominal Imaging, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., H1307, Stanford, CA, 94305, USA.
| | - R Brooke Jeffrey
- Division of Abdominal Imaging, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., H1307, Stanford, CA, 94305, USA
| | - Eric W Olcott
- Department of Radiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Atif Zaheer
- Department of Radiology, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD, 21287, USA
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29
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Kempeneers MA, Issa Y, Ali UA, Baron RD, Besselink MG, Büchler M, Erkan M, Fernandez-Del Castillo C, Isaji S, Izbicki J, Kleeff J, Laukkarinen J, Sheel ARG, Shimosegawa T, Whitcomb DC, Windsor J, Miao Y, Neoptolemos J, Boermeester MA. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology 2020; 20:149-157. [PMID: 31870802 DOI: 10.1016/j.pan.2019.12.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Chronic pancreatitis (CP) is a complex inflammatory disease with pain as the predominant symptom. Pain relief can be achieved using invasive interventions such as endoscopy and surgery. This paper is part of the international consensus guidelines on CP and presents the consensus guideline for surgery and timing of intervention in CP. METHODS An international working group with 15 experts on CP surgery from the major pancreas societies (IAP, APA, JPS, and EPC) evaluated 20 statements generated from evidence on 5 questions deemed to be the most clinically relevant in CP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the level of evidence available for each statement. To determine the level of agreement, the working group voted on the 20 statements for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach's alpha reliability coefficient. RESULTS Strong consensus was obtained for the following statements: Surgery in CP is indicated as treatment of intractable pain and local complications of adjacent organs, and in case of suspicion of malignant (cystic) lesion; Early surgery is favored over surgery in a more advanced stage of disease to achieve optimal long-term pain relief; In patients with an enlarged pancreatic head, a combined drainage and resection procedure, such as the Frey, Beger, and Berne procedure, may be the treatment of choice; Pancreaticoduodenectomy is the most suitable surgical option for patients with groove pancreatitis; The risk of pancreatic carcinoma in patients with CP is too low (2% in 10 year) to recommend active screening or prophylactic surgery; Patients with hereditary CP have such a high risk of pancreatic cancer that prophylactic resection can be considered (lifetime risk of 40-55%). Weak agreement for procedure choice in patients with dilated duct and normal size pancreatic head: both the extended lateral pancreaticojejunostomy and Frey procedure seems to provide equivalent pain control in patients. CONCLUSIONS This international expert consensus guideline provides evidenced-based statements concerning key aspects in surgery and timing of intervention in CP. It is meant to guide clinical practitioners and surgeons in the treatment of patients with CP.
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Affiliation(s)
- M A Kempeneers
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Y Issa
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - U Ahmed Ali
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - R D Baron
- Department of Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - M G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - M Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - M Erkan
- Department of Surgery, Koc University, Istanbul, Turkey
| | | | - S Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Japan
| | - J Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - J Kleeff
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Germany
| | - J Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Finland
| | - A R G Sheel
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - T Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - D C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, PA, USA
| | - J Windsor
- HBP/Upper GI Unit, Auckland City Hospital/Department of Surgery, University of Auckland, New Zealand
| | - Y Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, China
| | - J Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - M A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands.
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Balduzzi A, Marchegiani G, Andrianello S, Romeo F, Amodio A, De Pretis N, Zamboni G, Malleo G, Frulloni L, Salvia R, Bassi C. Pancreaticoduodenectomy for paraduodenal pancreatitis is associated with a higher incidence of diabetes but a similar quality of life and pain control when compared to medical treatment. Pancreatology 2020; 20:193-198. [PMID: 31952917 DOI: 10.1016/j.pan.2019.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/23/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Paraduodenal pancreatitis is a focal form of chronic pancreatitis that affects the groove area between the duodenum and the head of the pancreas. Consensus regarding surgical or nonsurgical management as the best treatment option is still lacking. METHODS We retrospectively evaluated all patients managed for PP at The Pancreas Institute of the University Hospital Trust of Verona from 1990 to 2017. The outcomes of surgical vs. medical treatment with regard to pain control, quality of life and pancreatic insufficiency were evaluated through specific questionnaires. RESULTS The final study population consisted of 75 patients: 62.6% underwent surgery, and 37.4% were managed without surgery. All surgical procedures consisted of pancreaticoduodenectomy. The median follow-up from the diagnosis of paraduodenal pancreatitis was 60 (12-240) months. Patients who underwent surgery experienced a similar incidence of steatorrhea (44.7 vs. 52.6%; p = 0.4) but a significantly higher incidence of diabetes (59.6 vs. 10.7%; p < 0.01) when compared to those managed without surgery. There was no difference in terms of reported chronic pain (Graded Chronic Pain Scale, median 0 vs. 1; p = 0.1) and quality of life (Pancreatitis QoL Instrument, median 82 vs. 79; p = 0.2). However, surgical patients reported a worse level of self-care activities associated with glycemic control (Diabetes Self-Management Questionnaire, median 20 vs. 28, p = 0.02). CONCLUSION In patients affected by paraduodenal pancreatitis, surgery and medical therapy seem to obtain similar results in terms of quality of life and pain control. However, surgery is associated with an increased prevalence of postoperative diabetes with consequent relevant issues with self-care management. Surgery should be considered only in selected patients after adequate medical treatment.
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Affiliation(s)
- A Balduzzi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - F Romeo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - A Amodio
- Gastroenterology Unit, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - N De Pretis
- Gastroenterology Unit, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Zamboni
- Pathology Unit, Hospital Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - G Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - L Frulloni
- Gastroenterology Unit, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - R Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - C Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
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31
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Wolske KM, Ponnatapura J, Kolokythas O, Burke LMB, Tappouni R, Lalwani N. Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach. Radiographics 2019; 39:1965-1982. [PMID: 31584860 DOI: 10.1148/rg.2019190011] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include mass-forming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm. Secondary imaging features such as the duct-penetrating sign, biliary or main pancreatic duct skip strictures, a capsulelike rim, the pancreatic duct-to-parenchyma ratio, displaced calcifications in patients with chronic calcific pancreatitis, the "double duct" sign, and vessel encasement or displacement can help to suggest the possibility of an inflammatory mass or a neoplastic process. An awareness of the secondary signs that favor a diagnosis of malignant or inflammatory lesions in the pancreas can help the radiologist to perform the differential diagnosis and determine the degree of suspicion for malignancy. Repeat biopsy or surgical resection may be necessary to achieve an accurate diagnosis and prevent unnecessary surgery for inflammatory conditions. Online supplemental material and DICOM image stacks are available for this article. ©RSNA, 2019.
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Affiliation(s)
- Kristy Marie Wolske
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Janardhana Ponnatapura
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Orpheus Kolokythas
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Lauren M B Burke
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Rafel Tappouni
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Neeraj Lalwani
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
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Addeo G, Beccani D, Cozzi D, Ferrari R, Lanzetta MM, Paolantonio P, Pradella S, Miele V. Groove pancreatitis: a challenging imaging diagnosis. Gland Surg 2019; 8:S178-S187. [PMID: 31559185 DOI: 10.21037/gs.2019.04.06] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Groove pancreatitis (GP) is an uncommon form of chronic pancreatitis (CP) involving the space between duodenum, pancreatic head and common bile duct (CBD) known as pancreatic-duodenal groove. Although an association with long-standing ethanol assumption is reported a definite etiology of GP is unknown. Since thickening of the duodenal wall, pancreatic head enlargement, CBD stricture and dilatation of pancreatic duct system are common findings the differential diagnosis with pancreatic head neoplasm by means of imaging can be challenging. However, some imaging findings such as fibrotic changes of the pancreatic groove and presence of duodenal wall cysts may suggest the correct diagnosis. In this paper we review clinical and imaging features of GP with emphasis on computed tomography (CT) and magnetic resonance imaging (MRI) findings.
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Affiliation(s)
- Gloria Addeo
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Beccani
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diletta Cozzi
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Riccardo Ferrari
- Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | | | - Pasquale Paolantonio
- Department of Radiology, Azienda Ospedaliera S. Giovanni-Addolorata, Rome, Italy
| | - Silvia Pradella
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Mikulić D, Bubalo T, Mrzljak A, Škrtić A, Jadrijević S, Kanižaj TF, Kocman B. Role of total pancreatectomy in the treatment of paraduodenal pancreatitis: A case report. World J Gastrointest Surg 2019; 11:296-302. [PMID: 31367277 PMCID: PMC6658362 DOI: 10.4240/wjgs.v11.i6.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/06/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Paraduodenal pancreatitis (PP) is a rare form of chronic pancreatitis presenting with symptoms of duodenal obstruction. Conservative treatment is often unsuccessful and pancreaticoduodenectomy is the preferred surgical approach. A mini review of the outcomes of surgical therapy for PP shows that the results of pancreaticoduodenectomy are predominantly favorable. CASE SUMMARY In our case report of PP, we describe an unusual course first presenting with the symptoms of chronic pancreatitis and a pseudocyst of the pancreatic tail. A pseudocystojejunostomy was performed and the late postoperative course was complicated with the symptoms of duodenal obstruction. At laparotomy, PP was found and the patient was treated with a total pancreatectomy. The postoperative course was uneventful and good weight gain with resolution of pain was demonstrated at follow up visits. CONCLUSION Surgery is currently the optimal treatment option for PP. It is also the best diagnostic tool in distinguishing between pancreatitis and pancreatic adenocarcinoma.
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Affiliation(s)
- Danko Mikulić
- Branislav Kocman - Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Tomislav Bubalo
- Branislav Kocman - Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Tajana Filipec Kanižaj - Division of Gastroenterology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb 10000, Croatia
| | - Anita Škrtić
- Department of Pathology and Cytology, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb 10000, Croatia
| | - Stipislav Jadrijević
- Branislav Kocman - Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
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Chantarojanasiri T, Isayama H, Nakai Y, Matsubara S, Yamamoto N, Takahara N, Mizuno S, Hamada T, Kogure H, Koike K. Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology. Gut Liver 2018; 12:208-213. [PMID: 29212312 PMCID: PMC5832346 DOI: 10.5009/gnl17170] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/14/2017] [Accepted: 06/26/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/AIMS Groove pancreatitis (GP) is an uncommon disease involving the pancreaticoduodenal area. Possible pathogenesis includes obstructive pancreatitis in the duct of Santorini and impaired communication with the duct of Wirsung, minor papilla stenosis, and leakage causing inflammation. Limited data regarding endoscopic treatment have been published. METHODS Seven patients with GP receiving endoscopic treatment were reviewed. The morphology of the pancreatic duct was evaluated by a pancreatogram. Endoscopic dilation of the minor papilla and drainage of the duct of Santorini were performed. RESULTS There were two pancreatic divisum cases, one ansa pancreatica case and four impaired connections between the duct of Santorini and the main pancreatic duct. Three to 31 sessions of endoscopy, with 2 to 24 sessions of transpapillary stenting and dilation, were performed. Interventions through the minor papilla were successfully performed in six of seven cases. The pancreatic stenting duration ranged from 2 to 87 months. Five patients with evidence of chronic pancreatitis (CP) tended to receive more endoscopic interventions than did the two patients without CP (2-24 vs 2, respectively) for GP and other complications associated with CP. CONCLUSIONS Disconnection or impairment of communication between the ducts of Santorini and Wirsung was observed in all cases of GP. No surgery was required, and endoscopic minor papilla dilation and drainage of the duct of Santorini were feasible for the treatment of GP.
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Affiliation(s)
- Tanyaporn Chantarojanasiri
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
- Department of Internal Medicine, Police General Hospital, Bangkok,
Thailand
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
| | - Saburo Matsubara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
| | - Natsuyo Yamamoto
- Department of Gastroenterology, Toshiba General Hospital, Tokyo,
Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
| | - Suguru Mizuno
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA,
USA
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
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Abstract
The pancreas is a complex organ that may give rise to large number of neoplasms and non-neoplastic lesions. This article focuses on benign neoplasms, such as serous neoplasms, and tumorlike (pseudotumoral) lesions that may be mistaken for neoplasm not only by clinicians and radiologists, but also by pathologists. The family of pancreatic pseudotumors, by a loosely defined conception of that term, includes a variety of lesions including heterotopia, hamartoma, and lipomatous pseudohypertrophy. Autoimmune pancreatitis and paraduodenal ("groove") pancreatitis may also lead to pseudotumor formation. Knowledge of these entities will help in making an accurate diagnosis.
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Affiliation(s)
- Olca Basturk
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Gokce Askan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Aguilera F, Tsamalaidze L, Raimondo M, Puri R, Asbun HJ, Stauffer JA. Pancreaticoduodenectomy and Outcomes for Groove Pancreatitis. Dig Surg 2018; 35:475-481. [PMID: 29346792 DOI: 10.1159/000485849] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/27/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS The operative management of groove pancreatitis (GP) is still a matter of controversy and pancreaticoduodenectomy (PD) can be a high-risk procedure for patients. The aim of this study was to report our 9-year experience of surgical resection for GP and to review relevant literature. METHODS A retrospective review of patients undergoing pancreatectomy for GP from August 1, 2008, through May 31, 2017 was performed. Patients with clinical, radiologic, and final pathologic confirmation of GP were included. Literature on the current understanding of GP was reviewed. RESULTS Eight patients from total 449 pancreatectomies met inclusion criteria. Four male and 4 female patients (mean age, 51.9 years; mean body mass index, 25.3) underwent pylorus-preserving pancreatoduodenectomy (3 by laparoscopy and 5 by open approach). Mean (range) operative time and blood loss was 343 (167-525) min and 218 (40-500) mL respectively. Pancreatic fistula and delayed gastric emptying were noted in one patient each. No major complications occurred, but minor complications occurred in 5 (62%) patients. Mean hospital stay was 6.1 (range 3-14) days. At median follow-up of 18.15 (interquartile range 7.25-33.8) months, all patients experienced a resolution of pancreatitis and improvement in symptoms. CONCLUSIONS PD is a safe procedure for GP. Short-term surgical outcomes are acceptable and long-term outcomes are associated with improved symptom control.
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Affiliation(s)
| | - Levan Tsamalaidze
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Tbilisi State Medical University, Tbilisi, Georgia
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ruchir Puri
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Horacio J Asbun
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - John A Stauffer
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Khalil RM, Gouda WA. CT findings of the commonly overlooked groove pancreatitis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Boninsegna E, Negrelli R, Zamboni GA, Tedesco G, Manfredi R, Pozzi Mucelli R. Paraduodenal pancreatitis as a mimicker of pancreatic adenocarcinoma: MRI evaluation. Eur J Radiol 2017; 95:236-241. [PMID: 28987673 DOI: 10.1016/j.ejrad.2017.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/28/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the MRI features of paraduodenal pancreatitis (PDP) and to define useful signs to differentiate PDP from pancreatic ductal adenocarcinoma (PDAC). MATERIAL AND METHODS We reviewed the MRI scans of 56 patients, 28 affected by PDP and 28 by PDAC, all pathologically proven. The following parameters were evaluated: signal intensity of the lesion on T1-, T2-WI, DWI (b800) and after contrast medium administration; presence of cysts; dilation of common hepatic duct and main pancreatic duct; focal thickening of the second portion of the duodenum; maximum diameter and volume of the lesion. RESULTS Both PDPs and PDACs were more frequently hypointense on T1-WI, iso-hyperintense on T2-WI, hypointense in the pancreatic phase and iso-hypointense in the venous phase (p>0.05); in the delayed phase most PDP were hyperintense (p=0.0031); on DWI 71.4% PDPs were isointense and all PDACs were hyperintense (p=0.0041). Cystic components were present in 85.7% PDPs (p=0.0011); double duct sign was present in 50% PDACs (p=0.0048); focal thickening of the duodenum was depicted in 89.3 PDPs (p=0.0012). PDPs were larger than PDACs (p=0.0003). CONCLUSION The most suggestive signs of PDP are: signal hyperintensity in the delayed phase, isointensity on DWI, presence of cysts, focal thickening of the duodenum and large size of the lesion.
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Affiliation(s)
- Enrico Boninsegna
- Department of Radiology, Policlinico G.B. Rossi, University of Verona, Italy.
| | - Riccardo Negrelli
- Department of Radiology, Policlinico G.B. Rossi, University of Verona, Italy
| | - Giulia A Zamboni
- Department of Radiology, Policlinico G.B. Rossi, University of Verona, Italy
| | - Giorgia Tedesco
- Department of Radiology, Policlinico G.B. Rossi, University of Verona, Italy
| | - Riccardo Manfredi
- Department of Radiology, Policlinico A. Gemelli, Catholic University, Rome, Italy
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Outcomes After Conservative, Endoscopic, and Surgical Treatment of Groove Pancreatitis: A Systematic Review. J Clin Gastroenterol 2017; 51:749-754. [PMID: 27875360 DOI: 10.1097/mcg.0000000000000746] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Groove pancreatitis (GP) is a focal form of chronic pancreatitis affecting the paraduodenal groove area, for which consensus on diagnosis and management is lacking. GOALS We performed a systematic review of the literature to determine patient characteristics and imaging features of GP and to evaluate clinical outcomes after treatment. RESULTS Eight studies were included reporting on 335 GP patients with a median age of 47 years (range, 34 to 64 y), with 90% male, 87% smokers, and 87% alcohol consumption, and 47 months (range, 15 to 122 mo) of follow-up. Most patients presented with abdominal pain (91%) and/or weight loss (78%). Imaging frequently showed cystic lesions (91%) and duodenal stenosis (60%).Final treatment was conservative (eg, pain medication) in 29% of patients. Endoscopic treatment (eg, pseudocyst drainage) was applied in 19% of patients-34% of these patients were subsequently referred for surgery. Overall, 59% of patients were treated surgically (eg, pancreatoduodenectomy). Complete symptom relief was observed in 50% of patients who were treated conservatively, 57% who underwent endoscopic treatment, and 79% who underwent surgery. CONCLUSIONS GP is associated with male gender, smoking, and alcohol consumption. The vast majority of patients presents with abdominal pain and with cystic lesions on imaging. Although surgical treatment seems to be the most effective, both conservative and endoscopic treatment are successful in about half of patients. A stepwise treatment algorithm starting with the least invasive treatment options seems advisable.
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40
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Carvalho D, Loureiro R, Pavão Borges V, Russo P, Bernardes C, Ramos G. Paraduodenal Pancreatitis: Three Cases with Different Therapeutic Approaches. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 24:89-94. [PMID: 28848788 DOI: 10.1159/000450872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/03/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Paraduodenal pancreatitis is a rare cause of chronic abdominal pain characterized by an inflammatory process and scarring in the groove area between the pancreatic head and the duodenal wall. Besides abdominal pain, symptoms such as vomiting and weight loss are common. Currently, advances in radiological and endoscopic diagnostic methods allow it to be identified without histological confirmation, although the differentiation from pancreatic adenocarcinoma could be challenging in some cases. Many therapeutic options are available nowadays including pharmacological, endoscopic, or surgical treatment. METHODS We report 3 cases of paraduodenal pancreatitis that had different therapeutic approaches. RESULTS AND CONCLUSION They show that this pathology should be taken into account in the differential diagnosis of pancreatic masses with duodenal infiltration, and that its management should be individualized and judicious.
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Affiliation(s)
- Diana Carvalho
- Gastroenterology and Hepatology Department, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Rafaela Loureiro
- Gastroenterology and Hepatology Department, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Verónica Pavão Borges
- Gastroenterology and Hepatology Department, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Pedro Russo
- Gastroenterology and Hepatology Department, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Bernardes
- Gastroenterology and Hepatology Department, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Gonçalo Ramos
- Gastroenterology and Hepatology Department, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Larjani S, Bruckschwaiger VR, Stephens LA, James PD, Martel G, Mimeault R, Balaa FK, Bertens KA. Paraduodenal pancreatitis as an uncommon cause of gastric outlet obstruction: A case report and review of the literature. Int J Surg Case Rep 2017; 39:14-18. [PMID: 28783521 PMCID: PMC5545816 DOI: 10.1016/j.ijscr.2017.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022] Open
Abstract
Paraduodenal pancreatitis is a rare form of focal chronic or recurrent pancreatitis that can present as gastric outlet obstruction. Endoscopic ultrasound and fine needle aspiration biopsy provides the best diagnostic modality. Key histopathologic features include Brunner gland hyperplasia, myofibroblastic proliferation, spindle cells and foamy cells. Cross-sectional imaging demonstrates a fibrotic, sheet-like mass with cystic change between the duodenal wall and pancreatic head. The optimal treatment for refractory symptoms is pancreaticoduodenectomy. Introduction Paraduodenal pancreatitis (PP) is an under-recognized form of focal chronic or recurrent pancreatitis. Since PP presents with non-specific symptoms and shares radiological and histopathological features with other entities, it can be challenging to diagnose. Presentation of case report Herein, a case of a 64 year-old Caucasian male with PP presenting with recurrent gastric outlet obstruction (GOO) is detailed. Over the course of two years, he underwent multiple balloon dilatations for symptom management. His diagnostic course was complicated by inconclusive and misleading biopsies. Conclusion PP can rarely present as GOO in otherwise asymptomatic patients. A preoperative pathologic diagnosis can be difficult to obtain, and in this case delayed definitive surgical management. The case is discussed in detail, and a concise review the current literature was undertaken.
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Affiliation(s)
- Soroush Larjani
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Vanessa R Bruckschwaiger
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Leslie A Stephens
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Paul D James
- Division of Gastroenteretology, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Guillaume Martel
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Richard Mimeault
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Fady K Balaa
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Kimberly A Bertens
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada.
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Zhu C, Huang Q, Zhu J, Zhang X, Qin X. Groove resection of pancreatic head in groove pancreatitis: A case report. Exp Ther Med 2017; 14:1983-1988. [PMID: 28962113 PMCID: PMC5609124 DOI: 10.3892/etm.2017.4753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 04/20/2017] [Indexed: 12/14/2022] Open
Abstract
Groove pancreatitis (GP) is a rare type of chronic pancreatitis, which primarily affects the groove area of the pancreatic head. Surgery is considered as the ultimate method for GP if the symptoms are not improved by conservative or endoscopic treatments, and the Whipple technique is the common choice at present. The present study introduces a novel surgical procedure for GP, namely groove resection of pancreatic head (GRPH), in a 56-year-old male patient. To the best of our knowledge, this is the first report on GRPH for the surgical treatment of GP. This patient was diagnosed with typical GP without any evidence of malignancy, based on imaging studies and gastrointestinal endoscopy, and was treated with GRPH. Briefly, only the groove area of the pancreatic head was resected, while the duodenum, the main pancreatic duct and the majority of the pancreatic head were preserved. A complete relief of abdominal pain and a weight gain were achieved 2 months after surgery. Endoscopic examination indicated marked improvement of the duodenal lesions. In conclusion, GRPH is a less invasive surgical procedure for GP compared with other surgical procedures and may be an alternative for the surgical treatment of GP without severe lesions or stenosis of the duodenum.
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Affiliation(s)
- Chunfu Zhu
- Department of Hepato-biliary-pancreatic Surgery, Changzhou No. 2 People's Hospital, Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Qin Huang
- Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System, Harvard Medical School, West Roxbury, MA 02132, USA
| | - Jianfei Zhu
- Department of Hepato-biliary-pancreatic Surgery, Changzhou No. 2 People's Hospital, Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Xudong Zhang
- Department of Hepato-biliary-pancreatic Surgery, Changzhou No. 2 People's Hospital, Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Xihu Qin
- Department of Hepato-biliary-pancreatic Surgery, Changzhou No. 2 People's Hospital, Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
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Antonini F, Macarri G. Endoscopic ultrasound for the diagnosis of an uncommon cause of obstructive jaundice masquerading as malignancy. Endosc Ultrasound 2017; 6:276-277. [PMID: 28663532 PMCID: PMC5579916 DOI: 10.4103/2303-9027.190926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 01/19/2016] [Indexed: 11/05/2022] Open
Affiliation(s)
- Filippo Antonini
- Department of Gastroenterology, A. Murri Hospital, Polytechnic University of Marche, Fermo, Italy
| | - Giampiero Macarri
- Department of Gastroenterology, A. Murri Hospital, Polytechnic University of Marche, Fermo, Italy
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Ray S, Ghatak S, Misra D, Dasgupta J, Biswas J, Khamrui S, Bandyopadhyay D, Ghosh R. Groove Pancreatitis: Report of Three Cases with Brief Review of Literature. Indian J Surg 2017; 79:344-348. [PMID: 28827910 DOI: 10.1007/s12262-017-1643-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 04/24/2017] [Indexed: 01/13/2023] Open
Abstract
Groove pancreatitis (GP) is a rare type of segmental pancreatitis, and it remains largely an unfamiliar entity to most physicians. It is often misdiagnosed as pancreatic cancer and autoimmune pancreatitis. With better understanding of radiological findings, preoperative differentiation is often possible. If there is preoperative diagnosis of GP, one can employ non-surgical treatment. But most of the patients ultimately require surgery. Pancreaticoduodenectomy (PD) is the surgical treatment of choice. We report three cases of GP that were treated by Whipple's operation at our unit. All the three patients had a history of long-standing alcohol intake. In the first and third patients, we had a preoperative diagnosis of GP. But, in the second patient, our pre-operative and intra-operative diagnosis was a pancreatic head malignancy. Diagnosis of GP was made only after histopathological examination. All the three patients had uneventful postoperative recovery and were well at 55-, 45- and 24-month follow-up respectively. In addition to detail descriptions of our three cases, a detailed review of the current literature surrounding this clinical entity is also provided in this article.
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Affiliation(s)
- Sukanta Ray
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal 700020 India
| | - Supriyo Ghatak
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal 700020 India
| | - Debashis Misra
- Division of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal 700020 India
| | - Jayanta Dasgupta
- Division of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal 700020 India
| | - Jayanta Biswas
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal 700020 India
| | - Sujan Khamrui
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal 700020 India
| | - Debottam Bandyopadhyay
- Division of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal 700020 India
| | - Ranajoy Ghosh
- Division of Pathology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal 700020 India
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45
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Abstract
OBJECTIVES This study aimed to evaluate the clinical and radiological features and clinical outcomes of paraduodenal pancreatitis (PP). METHODS A final diagnosis of PP was based on surgical specimens in resected patients and on imaging in nonoperated patients. Clinical, radiological, and pathological data were collected and reevaluated. RESULTS We studied 120 patients, 97.5% of whom were drinkers and 97.5% were smokers. Symptoms at clinical onset were acute pancreatitis in 78 patients (65%) and continuous pain in 68 patients (55.8%). Other symptoms were vomiting (36.7%), weight loss (25.8%), and jaundice (11.7%). Cystic variant was diagnosed in 82 patients (68.0%), and solid variant was diagnosed in 38 patients (32.0%). Pure and diffuse forms were observed in 22 (18.3%) and 98 (81.7%) patients, respectively. Pancreatic calcifications were present at clinical onset in 5.0% of the patients and in 61.0% at the end of follow-up. Somatostatin analogs were used in 13 patients (10.8%), and 81 patients (67.0%) underwent surgery. CONCLUSIONS The clinical profile of PP was found to be middle-aged men who were heavy drinkers and smokers with painful pancreatitis and was associated with vomiting and weight loss. In nonresponders, alcohol withdrawal and medical therapy can be proposed as a first-line treatment, and surgery as a second-line treatment.
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46
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Kim DU, Lubner MG, Mellnick VM, Joshi G, Pickhardt PJ. Heterotopic pancreatic rests: imaging features, complications, and unifying concepts. Abdom Radiol (NY) 2017; 42:216-225. [PMID: 27544356 DOI: 10.1007/s00261-016-0874-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The spectrum of pancreatic heterotopia will be reviewed, including clinical features, potential complications, and imaging manifestations. This will also include a review of various entities associated with pancreatic heterotopia such as groove pancreatitis and cystic dystrophy of gastroduodenal heterotopic pancreas. These entities were previously thought of as distinct histopathologic entities but now appear to represent manifestations of pancreatic heterotopia. CONCLUSION Pancreatic heterotopia and heterotopic pancreatitis can have a wide range of appearances. Several entities, which were previously thought to be distinct, can be considered manifestations of pancreatic heterotopia and heterotopic pancreatitis.
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Affiliation(s)
- David U Kim
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI, 53792-3252, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI, 53792-3252, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S, Kingshighway Blvd, Box 8131, St. Louis, MO, 63110, USA
| | - Gayatri Joshi
- Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, 550 Peachtree St, Ground Floor, Atlanta, GA, 30308, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI, 53792-3252, USA.
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47
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Lekkerkerker SJ, Nio CY, Issa Y, Fockens P, Verheij J, Busch OR, van Gulik TM, Rauws EA, Boermeester MA, van Hooft JE, Besselink MG. Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis. J Gastroenterol Hepatol 2016; 31:1895-1900. [PMID: 26997497 DOI: 10.1111/jgh.13376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Data on non-surgical treatment of groove pancreatitis (GP) and the risk of cancer are lacking. We aimed to determine the prevalence and predictors of cancer in patients in whom the diagnosis GP was considered, and to evaluate symptom improvement after treatment. STUDY Patients referred with possible GP (2001-2014) were retrospectively included. An experienced radiologist reassessed imaging. GP patients received questionnaires evaluating their symptoms. RESULTS From the 38 possible GP patients, 10 had cancer (26%) and 28 GP (74%). Compared with cancer patients, GP patients more frequently had cysts (2/10 vs. 18/28, P = 0.03), less often jaundice (6/10 vs 3/27, P < 0.01), an abrupt caliber change of the CBD (5/10 vs. 2/28, P < 0.01) or suspicious cytology (5/9 vs 2/20, P = 0.02). Of the 28 GP patients, 14 patients were treated conservatively of whom 12 reported symptom improvement after a median follow-up of 45 months (range 7-127 months). All 6 patients treated endoscopically and 7/8 patients treated surgically reported symptom improvement. Surgery, performed because of treatment failure (3/8) or inability to exclude malignancy (5/8), caused mortality in 1/8 patients. CONCLUSIONS Suspicion of pancreatic cancer should be high in patients presenting with possible GP. Conservative, endoscopic and surgical treatment can all lead to symptom improvement, suggesting a 'step-up approach' to GP once cancer is excluded.
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Affiliation(s)
- Selma J Lekkerkerker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Chung Y Nio
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yama Issa
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joanne Verheij
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik A Rauws
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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48
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Abstract
Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is multifactorial and involves complex interaction of environmental, genetic, and/or other risk factors. The pathology is dependent on the underlying pathogenesis of the disease. This review describes the clinical, gross, and microscopic findings of the main subtypes of chronic pancreatitis: alcoholic chronic pancreatitis, obstructive chronic pancreatitis, paraduodenal ("groove") pancreatitis, pancreatic divisum, autoimmune pancreatitis, and genetic factors associated with chronic pancreatitis. As pancreatic ductal adenocarcinoma may be confused with chronic pancreatitis, the main distinguishing features between these 2 diseases are discussed.
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49
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Kriger AG, Smirnov AV, Berelavichus SV, Gorin DS, Karmazanovskiy GG, Vetsheva NN, Nerestyuk YI, Kalinin DV, Glotov AV. [Diagnosis and treatment of duodenal dystrophy in patients with chronic pancreatitis]. Khirurgiia (Mosk) 2016:25-32. [PMID: 27628227 DOI: 10.17116/hirurgia2016825-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM to define optimal treatment of duodenal dystrophy in patients with chronic pancreatitis. MATERIAL AND METHODS 515 patients with chronic pancreatitis have been treated for the period 2004-2015 in A.V.Vishnevsky Institute of Surgery. Duodenal dystrophy (DD) was diagnosed in 79 (15.3%) of them. The diagnosis was confirmed by sonography, CT, MRI and endosonography. 5 patients are under observation without surgery. 74 patients were operated after previous medical therapy during 39 months on the average. Pancreatoduodenectomy was performed in 36 patients. Organ-sparing interventions were applied in 34 cases including different duodenal resections in 20 patients and pancreatic head resections in different modifications in 14 cases. 4 patients underwent palliative surgery. Chronic pancreatitis and DD were verified by morphological analysis of specimens. Long-term results were estimated in 47 patients. Median follow-up was 49.9 months. RESULTS X-ray diagnostics showed that DD was combined with chronic pancreatitis in 87.3% of cases while morphological analysis revealed 93.8%. Clinical signs of DD were caused by striated pancreatitis in 69.6% and ectopic pancreatic tissue in 30.4%. Clinical manifestations of DD did not depend on its cause and were presented by symptoms of chronic pancreatitis. Postoperative complications occurred in 25 (34.7%) patients. There were 33.5% of complications after pancreatoduodenectomy and 70% after duodenal resection. 1 patient died. Overall mortality was 1,3%. In long-term period complete regression of symptoms was observed in 66% of cases, significant improvement - in 32%, absence of the effect - in 2%. CONCLUSION Medical therapy should be preferred for patients with DD and chronic pancreatitis. Surgery is indicated in case of persistent pain, complicated course of chronic pancreatitis and duodenal obstruction. Pancreatoduodenectomy and pancreatic head resection are preferred.
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Affiliation(s)
- A G Kriger
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Smirnov
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - S V Berelavichus
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - D S Gorin
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - G G Karmazanovskiy
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - N N Vetsheva
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Ya I Nerestyuk
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - D V Kalinin
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Glotov
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
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50
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Desai GS, Phadke A, Kulkarni D. Cystic Dystrophy of the Duodenum Due to Heterotopic Pancreas - A Case Report and Review of Literature. J Clin Diagn Res 2016; 10:PD11-PD13. [PMID: 27790515 DOI: 10.7860/jcdr/2016/20798.8498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022]
Abstract
Cystic Dystrophy and Heterotopic Pancreas (CDHP) is a rare cause of chronic pancreatitis, duodenal obstruction and obstructive jaundice. The diagnosis is often delayed and requires multimodal imaging with Computed Tomography (CT), Magnetic Resonance Cholangio-Pancreatography (MRCP) and Endoscopic Ultrasound (EUS). The treatment is not standardized but Pancreatoduodenectomy (PD) provides long-term relief in some cases. The present case is about a 47-year-old male with history of alcohol abuse for 10 years who presented with a history of recurrent acute pancreatitis. CT scan revealed bulky head of pancreas with a hypodense area between pancreatic head and second part of duodenum, prominent pancreatic duct, Dilated Common Bile Duct (CBD) (15mm) and stenosis of second part of duodenum. EUS confirmed CT findings. A Fine Needle Aspiration Cytology (FNAC) showed only inflammatory infiltrate. A diagnosis of groove pancreatitis was made. The patient was subjected to a pylorus preserving PD. Histopathological examination showed cystic dystrophy of duodenum due to heterotopic pancreas. The patient is doing well at 5 years of follow-up.
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Affiliation(s)
- Gunjan Shailesh Desai
- Registrar, Department of Gastrointestinal Surgery, Lilavati Hospital & Research Centre , Bandra West, Mumbai, Maharashtra, India
| | - Aniruddha Phadke
- Consultant, Department of Medical Gastroenterology, Lilavati Hospital & Research Centre , Bandra West, Mumbai, Maharashtra, India
| | - Dattaprasanna Kulkarni
- Consultant, Department of Gastrointestinal Surgery, Lilavati Hospital & Research Centre , Bandra West, Mumbai, Maharashtra, India
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