Paraduodenal pancreatitis

Abstract

Paraduodenal pancreatitis is a distinct clinicopathological entity involving the duodenum and the pancreatic tissue in the vicinity of the minor papilla. Most afflicted patients are young alcoholic males who present clinically with upper abdominal pain, weight loss, nausea, and vomiting. Pancreatic tissue elements in the duodenal wall and impedance to exocrine pancreatic secretions at the minor papilla are key factors in the pathogenesis of this condition. On imaging, the condition may manifest as a solid fibrotic mass around the minor papilla or as cysts in the duodenum and the pancreaticoduodenal groove. Duodenal stenosis, biliary strictures, chronic calcifying pancreatitis, and pancreatic ductal dilatation are also often observed.

Paraduodenal Pancreatitis: Three Cases with Different Therapeutic Approaches

“…Histologically, the most characteristic findings consist of myofibroblastic and neural expansion into the groove area, thickening of the duodenal wall with fibrosis and Brunner's gland and smooth muscle hyperplasia, occurrence of dilated ducts as well as pseudocysts within the duodenal wall, and the presence of hypercellullar granulation tissue and foreign body type giant cells [1,12] . Cytology from fragments obtained by EUS can show a wide range of results, frequently with observation of spindled stromal cells.…”

“…Diverse pathologies are included in the differential diagnosis: pancreatic adenocarcinoma, cystic tumors, autoimmune pancreatitis [8] , duodenal carcinoma, cholangiocarcinoma, and acute relapsing pancreatitis. The first one is particularly challenging even with resource to imagiology and endoscopic modalities [1] .…”

“…It reveals a hypoechoic area between the duodenal wall and the head of the pancreas, thickening and stenosis of the duodenal wall, intramural cysts and a slightly narrowing of the main biliary duct. Eventually, in cases of segmental PP, it is possible to see infiltration and calcification of pancreatic parenchyma, pseudocysts, and dilation of pancreatic duct [1,4] . EUS-FNA has limited value in this setting and depends on the biopsy site and its interpretation, being difficult to exclude a subjacent tumor [6] .…”

“…Paraduodenal pancreatitis (PP) is a pathological condition resulting from fibrotic inflammation that involves the duodenal wall closely to the minor papilla, the adjacent pancreatic parenchyma, and the area between them [1] . Its pathophysiology remains unclear, although it is believed that alcohol consumption and the presence of ectopic pancreatic tissue in the duodenal wall may play a major role in its development [2] .…”

Pancreatic Solid Focal Lesions: Differential Diagnosis between Autoimmune Pancreatitis and Pancreatic Cancer

“…In females, paraduodenal pancreatitis is detected in 10-20% of all cases and similarly, 10-20% of cases of paraduodenal pancreatitis are reported in non-alcoholics. Alcohol consumption and the presence of ectopic pancreatitis tissue in the duodenal wall are believed to be key factors in the development of paraduodenal pancreatitis [6]. Increasingly viscous pancreatic secretions, typically found in individuals with a history of alcohol abuse, predisposition to calculi formation and higher concentration of the protein in pancreatic secretions all play an important role in the pathogenesis of paraduodenal pancreatitis.…”