Characteristic clinical and pathologic features for preoperative diagnosed groove pancreatitis

Abstract

PurposeGroove pancreatitis is a rare specific form of chronic pancreatitis that extends into the anatomical area between the pancreatic head, the duodenum, and the common bile duct, which are referred to as the groove areas. We present the diagnostic modalities, pathological features and clinical outcomes of a series of symptomatic patients with groove pancreatitis who underwent pancreaticoduodenectomy.MethodsSix patients undergoing pancreaticoduodenectomy between May 2006 and May 2009 due to a clinical diagnosis of symptomatic groove pancreatitis were retrospectively included in the study.ResultsFive cases were male and one case was female, with a median age at diagnosis of 50 years. Their chief complaints were abdominal pain and vomiting. Abdominal computed tomography, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography were performed. Preoperative diagnosis of all patients was groove pancreatitis. Histological finding was compatible with clinically diagnosed groove pancreatitis in five patients and the pathologic diagnosis of the remaining patient was adenocarcinoma of distal common bile duct. Following pancreaticoduodenectomy, four living patients experienced significant pain alleviation.ConclusionThe diagnostic imaging modalities of choice for groove pancreatitis are computed tomography and endoscopic ultrasonography. If symptomatic groove pancreatitis is suspected, careful follow-up of patients is necessary and pancreaticoduodenectomy seems to be a reasonable treatment option.

Groove Pancreatitis: Spectrum of Imaging Findings and Radiology-Pathology Correlation

“…Alternatively, patients with a chronic presentation often have evidence of jaundice (as a result of distal common bile duct narrowing and strictures) and chronic weight loss, features that are often more suggestive of an underlying malignancy, rather than pancreatitis. The average duration of symptoms is usually 3–6 months, although time courses significantly shorter or longer have been described [4, 7]. …”

“…Instead, the typical patient course usually involves repeated non-diagnostic fine-needle aspiration (FNA) performed using endoscopic ultrasound guidance, followed by pancreaticoduodenectomy to exclude an underlying pancreatic head, ampullary, or duodenal malignancy [3, 7, 9]. …”

Dual-phase CT findings of groove pancreatitis

“…The CBD strictures seen in the patients were smooth and tapering indicative of an inflammatory etiology. Furthermore, cystic changes seen in the pancreatic head may be mistaken for intrapancreatic mucinous neoplasm (IPMN) which are pre-cancerous lesions leading to surgery in a significant number of patients because of an inability to reliably make the differentiation on imaging [1,18,21]. Although the cystic lesions seen in the pancreatic head in our patient group represented chronic pseudocysts associated with chronic pancreatitis, chronic pancreatitis itself may be a risk factor for IPMN and subsequent development of pancreatic cancer [22].…”

Groove (paraduodenal) pancreatitis: Report of two cases

“…In another series of six patients with groove pancreatitis, one patient was diagnosed as distal common bile duct carcinoma after the operation. This patient was an elderly female with no history of alcohol consumption (13).…”