1
|
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.
Collapse
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.)
| |
Collapse
|
2
|
Kurihara K, Nakai Y, Fujishiro M. "Hitch-and-ride" for the major to minor rendezvous in a patient with groove pancreatitis. Dig Endosc 2024; 36:234-235. [PMID: 37927161 DOI: 10.1111/den.14707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
Watch a video of this article.
Collapse
Affiliation(s)
- Kohei Kurihara
- 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
- Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
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
| |
Collapse
|
5
|
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:jpm13040644. [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] [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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Groove Pancreatitis-Tumor-like Lesion of the Pancreas. Diagnostics (Basel) 2023; 13:diagnostics13050866. [PMID: 36900010 PMCID: PMC10001155 DOI: 10.3390/diagnostics13050866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
Groove pancreatitis (GP) is an uncommon appearance of pancreatitis represented by fibrous inflammation and a pseudo-tumor in the area over the head of the pancreas. The underlying etiology is unidentified but is firmly associated with alcohol abuse. We report the case of a 45-year-old male patient with chronic alcohol abuse who was admitted to our hospital with upper abdominal pain radiating to the back and weight loss. Laboratory data were within normal limits, except for the level of carbohydrate antigen (CA) 19-9. An abdominal ultrasound and computed tomography (CT) scan revealed swelling of the pancreatic head and duodenal wall thickening with luminal narrowing. We performed an endoscopic ultrasound (EUS) with fine needle aspiration (FNA) from the markedly thickened duodenal wall and the groove area, which revealed only inflammatory changes. The patient improved and was discharged. The principal objective in managing GP is to exclude a diagnosis of malignancy, whilst a conservative approach might be more acceptable for patients instead of extensive surgery.
Collapse
|
8
|
López-Muñoz P, Lorenzo-Zúñiga V, Alonso-Lázaro N, García-Campos M, Argüello L, Bustamante-Balén M, Pons-Beltrán V. Endoscopic findings of paraduodenal or groove pancreatitis. Endoscopy 2022; 54:E735-E736. [PMID: 35272375 DOI: 10.1055/a-1773-0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Pedro López-Muñoz
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe/IIS La Fe, Valencia, Spain
| | - Vicente Lorenzo-Zúñiga
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe/IIS La Fe, Valencia, Spain
| | - Noelia Alonso-Lázaro
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe/IIS La Fe, Valencia, Spain
| | - María García-Campos
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe/IIS La Fe, Valencia, Spain
| | - Lidia Argüello
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe/IIS La Fe, Valencia, Spain
| | - Marco Bustamante-Balén
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe/IIS La Fe, Valencia, Spain
| | - Vicente Pons-Beltrán
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Universitari i Politècnic La Fe/IIS La Fe, Valencia, Spain
| |
Collapse
|
9
|
Ikemura M, Tomishima K, Ota H, Kabemura D, Ushio M, Fukuma T, Takahashi S, Suzuki A, Takasaki Y, Ito K, Ishii S, Fujisawa T, Isayama H. A case of groove pancreatitis with duodenal stenosis successfully treated by endoscopic ultrasonography‐guided pancreaticogastrostomy. DEN OPEN 2022; 3:e190. [PMCID: PMC9710561 DOI: 10.1002/deo2.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 12/03/2022]
Abstract
One of the reasons for groove pancreatitis is caused by the leakage of pancreatic juice into the space between the pancreatic head, descending duodenum, and common bile duct. Endoscopic drainage of Santorini's duct (SD) via the minor papilla is reportedly efficacious but can be difficult due to duodenal stenosis. We report Santorini's duct drainage using endoscopic ultrasonography‐guided pancreaticogastrostomy (EUS‐PGS) for a case of groove pancreatitis with gastric outlet obstruction. Gastric outlet obstruction was improved after 7 months of EUS‐PGS with internal drainage through the Santorini's duct/minor papilla. EUS‐PGS may be effective for treating groove pancreatitis with duodenal stenosis. This is the first report of groove pancreatitis with duodenal stenosis, the symptoms of which were improved by EUS‐PGS.
Collapse
Affiliation(s)
- Muneo Ikemura
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Ko Tomishima
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Hiroto Ota
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Daishi Kabemura
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Mako Ushio
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Taito Fukuma
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Sho Takahashi
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Akinori Suzuki
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Yusuke Takasaki
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Koichi Ito
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Shigeto Ishii
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Toshio Fujisawa
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| |
Collapse
|
10
|
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.
Collapse
|
11
|
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: 4] [Impact Index Per Article: 2.0] [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.
Collapse
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
| |
Collapse
|
12
|
Upper Gastrointestinal Bleeding as a Debut Form of Groove Pancreatitis: A Diagnostic Challenge. Case Rep Surg 2022; 2022:5562778. [PMID: 35295320 PMCID: PMC8920698 DOI: 10.1155/2022/5562778] [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] [Received: 09/01/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction. Groove pancreatitis (GP) is an unusual subtype of chronic pancreatitis that affects the groove area. Differential diagnosis between groove pancreatitis and pancreatic carcinoma (PC) can be challenging, both clinically and radiologically. Our aim is to report the first case of GP debut with upper gastrointestinal bleeding (UGB). Case Report. A 53-year-old man with a personal history of alcohol and tobacco abuse and chronic pancreatitis was admitted to the hospital for epigastric abdominal pain. A computed tomography scan showed a locally advanced neoformative lesion in the distal stomach. The patient presented melena, arterial hypotension, and 4.4 g/dl of hemoglobin. An upper gastrointestinal endoscopy showed a neoformative ulcerated lesion at the duodenal bulb without active bleeding. Biopsies were taken, and histopathological analysis did not show malignancy. A cephalic pancreaticoduodenectomy was performed, and the postoperative period was uneventful. Histopathological analysis revealed a segmental GP. Discussion. GP is an uncommon entity, and its clinical and radiological presentation mimics PC. However, with advances in imaging tests, several radiological criteria have been described to distinguish GP from PC preoperatively. Although some authors recommend a stepwise management with initial conservative therapy, a therapeutic strategy has not yet been established. Conclusion. GP is an uncommon type of focal pancreatitis that should be considered as a differential diagnosis of PC. We report the first clinical case of GP whose debut with UGB presented a greater diagnostic and therapeutic challenge.
Collapse
|
13
|
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 2022:1-8. [PMID: 35138983 DOI: 10.1080/00365521.2022.2036806] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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.
Collapse
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
| |
Collapse
|
14
|
Bacalbasa N, Balescu I, Dima S, Popescu I. Pancreatoduodenectomy for groove pancreatitis: A case report and literature review. Exp Ther Med 2021; 22:1455. [PMID: 34737795 DOI: 10.3892/etm.2021.10890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022] Open
Abstract
Groove pancreatitis represents a rare pathological condition which is usually associated with chronic alcohol intake. However, the differential diagnosis between groove pancreatitis and groove pancreatic carcinoma is difficult to establish pre-operatively. In this respect, a significant number of cases are treated as malignant conditions, with the final diagnosis of benign disease being established post-operatively. The present study describes the case of a 46-year-old male who was diagnosed with groove pancreatitis. Due to the uncertainty of the pre-operative diagnosis, the patient was subjected to radical surgery consisting of pancreatoduodenectomy. The final histopathological diagnosis confirmed the presence of groove pancreatitis. Moreover, it excluded the possibility of an association with any element of malignancy and provided the effective management of the disease, all the symptoms being significantly alleviated at the 3-month follow-up. In addition, the present study also provides a brief summary and discussion of the disease and associated treatment options. On the whole, as demonstrated herein, pancreatoduodenectomy appears to be a safe and effective method for the treatment of groove pancreatitis, being associated with a significant improvement in the quality of life of the patient; moreover, it represents the sole method which can exclude the diagnosis of malignancy.
Collapse
Affiliation(s)
- Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Simona Dima
- Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Irinel Popescu
- Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Visceral Surgery, 'Titu Maiorescu' University of Medicine and Pharmacy, 040051 Bucharest, Romania
| |
Collapse
|
15
|
Laudari U, Ghimire R, Pradhan R, Maharjan DK, Thapa PB. Diagnostic Dilemma in Groove Pancreatitis: A Case Report. JNMA J Nepal Med Assoc 2020; 58:934-937. [PMID: 34506416 PMCID: PMC7775025 DOI: 10.31729/jnma.5301] [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] [Received: 08/20/2020] [Indexed: 11/18/2022] Open
Abstract
Groove pancreatitis is an uncommon form of chronic pancreatitis common in patients with a history of smoking and alcohol abuse. A high index of suspicion is required as it may masquerade pancreatic ductal adenocarcinoma and both of these conditions are difficult to differentiate preoperatively. Pancreaticoduodenectomy has a good outcome in a patient with Groove pancreatitis. Hence, we are reporting a case report of Groove pancreatitis in 40 years gentleman, who was being managed by multiple endoscopic dilatations, later underwent pancreaticoduodenectomy for persistent symptoms. He had no perioperative morbidity and doing well in 24 months follow up.
Collapse
Affiliation(s)
- Uttam Laudari
- Department of Surgery, Hospital for Advanced Medicine and Surgery, Dhumbarahi, Kathmandu, Nepal
| | - Roshan Ghimire
- Department of Surgery, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - Rosi Pradhan
- Department of Anaesthesiology, KIST Medical College, Imadol, Lalitpur, Nepal
| | | | - Prabin Bikram Thapa
- Department of Surgery, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| |
Collapse
|
16
|
Tahara K, Kanamori Y, Miyake K, Kudo Y, Fujita T, Kutsukake M, Mori T, Yamada Y, Fujino A, Shimizu H, Arai K, Tsutsumi Y, Miyazaki O. Groove pancreatitis treated by duodenal and biliary bypass. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
17
|
Kim GM, Ko SY, Wang JH. Spontaneous Resolution of Hemorrhagic Pseudocyst-Associated Pseudoaneurysm in Groove Pancreatitis. Case Rep Gastroenterol 2020; 14:131-136. [PMID: 32355482 PMCID: PMC7184797 DOI: 10.1159/000502836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/19/2022] Open
Abstract
Hemorrhagic pseudocyst (HP) and pseudocyst-associated pseudoaneurysms (PPs) are complications of pseudocyst. Angiography with embolization has been advocated as the first-line intervention for HP. A 47-year-old man with groove pancreatitis combined with HP near the pancreatic head was treated conservatively. He had relapsed pancreatitis with a newly identified pseudoaneurysm; however, the pseudocyst size was reduced. Although pseudoaneurysm was identified, angiography was not performed because there was no evidence of ongoing bleeding, and he was in a stable condition. Sphincterotomy and stent insertion in the pancreatic duct was applied to prevent relapsed pancreatitis with facilitation of the flow of pancreatic juice. He has done well during the 10-month follow-up, without recurrent pancreatitis. Angiography as an initial approach in HP and PPs may need to be more selective depending on the clinical presentation of the patient. A lysed clot within the strictured pancreatic duct during the healing process has been thought to be the cause of relapsed pancreatitis, and pancreatic sphincterotomy and stent insertion should be the preferred treatment methods.
Collapse
Affiliation(s)
- Gwang Mo Kim
- Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Soon Young Ko
- Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea.,Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Republic of Korea
| | - Joon Ho Wang
- Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea.,Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Republic of Korea
| |
Collapse
|