Groove Pancreatitis and Pancreatic Heterotopia in the Minor Duodenal Papilla

Abstract

Groove pancreatitis is a rare form of segmental chronic pancreatitis that involves the anatomic space between the head of the pancreas, the duodenum, and the common bile duct. We report 2 cases of groove pancreatitis with pancreatic heterotopia in the minor papilla. Patients were a 44-year-old woman and a 47-year-old man. Both had a past history of alcohol consumption and presented with abdominal pain, vomiting, and weight loss caused by duodenal stenosis. Abdominal computed tomography revealed thickening of the duodenal wall and enlargement of the pancreatic head in both patients. In 1 patient, ultrasound endoscopy showed a dilated duct in the head of the pancreas. Pancreaticoduodenectomy was performed to rule out pancreatic adenocarcinoma and because of the severity of the symptoms. In both cases, gross and microscopic examinations showed fibrous scar of the groove area. The Santorini duct was dilated and contained protein plugs in both patients, with abscesses in 1 of them. In both cases, there were microscopic foci of heterotopic pancreas with mild fibrosis in the wall of the minor papilla. Groove pancreatitis is often diagnosed in middle-aged alcoholic men presenting with clinical symptoms caused by duodenal stenosis. The pathogenesis of this rare entity could be because of disturbance of the pancreatic secretion through the minor papilla. Pancreatitis in heterotopic pancreas located in the minor papilla and chronic consumption of alcohol seem to be important pathogenic factors.

Pancreatoduodenal Junction: Review of Anatomy and Pathologic Conditions

“…Cystic changes are frequently encountered according to most accepted theories; they represent cystic dystrophy of a heterotopic pancreas tissue in the duodenal wall. 18 Two forms of the disease can be recognized, the pure and the segmental one. 19 The pure form Punctate calcification can be seen.…”

Groove pancreatitis: a diagnostic challenge

“…The different aspects of microscopic pathologic features associated with GP are reflected by the various terms describing this entity in the literature: cystic dystrophy of the heterotopic pancreas, pancreatic hamartoma of the duodenum, para-duodenal wall cyst, myoadenomatosis, paraduodenal pancreatitis and pseudotumor [10][11][12][13][14][15][16][17][18]. In typical cases the duodenal wall in the vicinity of the minor papilla shows proliferation of myoid cells (Fig.…”

Pancreaticoduodenectomy for the Treatment of Groove Pancreatitis

“…Clinically it presents in a relatively younger population (40-50 years old), usually males, with recurrent or chronic pancreatitis, significant weight loss from duodenal obstruction, and pancreatic head mass lesions on cross-sectional imaging [1,2]. Jaundice is rare (see Table 1).…”