Groove Pancreatitis

Abstract

Groove pancreatitis is a segmental chronic pancreatitis that affects the anatomical area between the pancreatic head, the duodenum, and the common bile duct, referred to as the groove area. Most patients with groove pancreatitis are males aged 40–50 years with a history of alcohol abuse. In about 20% of patients undergoing pancreaticoduodenectomy to treat chronic pancreatitis, groove pancreatitis is detected. The clinical symptoms are weight loss, upper abdominal pain, postprandial vomiting, and nausea due to duodenal stenosis. The pathogenesis of groove pancreatitis is thought to be anatomical or functional obstruction of the minor papilla. The viscosity of pancreatic juice increases due to excessive alcohol consumption and/or smoking, leading to calcification of the pancreatic duct. According to these conditions, pancreatitis in the groove area might arise due to impaired pancreatic juice outflow. The descending part of the duodenum is usually stenotic. Severe fibrosis and scarring are evident in the groove area. Characteristic pathological findings are cystic lesions in the duodenal wall, Brunner gland hyperplasia, dilation of Santorini’s duct and protein plaques in the pancreatic duct. A differential diagnosis of groove pancreatitis from peripancreatic cancer is clinically important. Cystic lesions in the duodenal wall and smooth stenosis of the bile duct are important findings of groove pancreatitis revealed by endoscopic ultrasonography, computed tomography and magnetic resonance imaging. Biopsy through the duodenum is also useful for diagnosis. Conservative treatment options include endoscopic stenting of the minor papilla, but long-term outcomes remain unclear. Pancreatoduodenectomy is a rational treatment for symptomatic groove pancreatitis.

Pancreatic groove cancer

“…However, arteries in pancreatic head lesions are often encased in pancreatic cancer but rarely in groove pancreatitis. [3,14] Nevertheless, it is vital to include the differential diagnosis of pancreatic groove cancer in any questionable case, before making the diagnosis of groove pancreatitis. The possibility of pancreatic groove cancer should be carefully excluded.…”

Diagnosis and treatment of duodenal dystrophy in patients with chronic pancreatitis

“…Кроме того, встречается и циркулярный характер поражения. Нагноения, кро-воизлияния в просвет или разрыв кист бывают край-не редко [4,21,24].…”

“…Причиной развития бороздчатого панкреатита считают нарушение оттока панкреатического секре-та через малый сосочек ДПК [24].…”

Difficult Diagnostic Problems in Pancreatobiliary Neoplasia

“…22 Embedded within the lesion are cystic spaces lined by granulation tissue, prompting the designation cystic dystrophy of heterotopic pancreas, or paraduodenal wall cyst, 24 and exuberant Brunner gland hyperplasia is invariably seen. 25 Although this form of pancreatitis may mimic pancreatic carcinoma clinically, the histologic features are generally unequivocally benign and the few ''atypical'' pancreatic ducts embedded within the lesion do not raise a concern for malignancy. However, similar to other mass-forming variants of chronic pancreatitis, the strong clinical suspicion for malignancy may bias the pathologist into suspecting a well-differentiated adenocarcinoma.…”