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Neto do Nascimento C, Palmela C, Soares AS, Antunes ML, Fidalgo CA, Glória L. Groove Pancreatitis: Clinical Cases and Review of the Literature. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:437-443. [PMID: 38476156 PMCID: PMC10928862 DOI: 10.1159/000526855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/06/2022] [Indexed: 03/14/2024]
Abstract
Introduction Groove pancreatitis (GP) is a type of chronic segmental pancreatitis that affects the pancreatoduodenal groove area, and it is often misdiagnosed. Outflow obstruction of the minor papilla associated with alcohol consumption seems to be the main pathophysiological mechanism, and it affects mainly middle-aged males. Symptoms include nausea and postprandial vomiting from gastric outlet obstruction, weight loss, and abdominal pain. Despite modern advances, such as radiological and endoscopic methods, distinction between GP and pancreatic cancer remains a challenge, and histological examination is sometimes necessary. When a diagnosis can be obtained without a surgical specimen, management can be conservative in the absence of acute or chronic complications. Case Presentation The authors present 2 clinical cases which portray the diagnostic workup and management decisions of this entity. Discussion/Conclusion GP is a clinical entity, offering diagnostic and therapeutic challenges. Imaging exams are crucial in the diagnosis and follow-up, but surgery may be necessary in a significant number of cases due to the incapacity to rule out malignancy.
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Affiliation(s)
| | - Carolina Palmela
- Gastroenterology Department, Beatriz Ângelo Hospital, Loures, Portugal
| | | | | | | | - Luísa Glória
- Gastroenterology Department, Beatriz Ângelo Hospital, Loures, Portugal
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Kulkarni CB, Moorthy S, Pullara SK, Prabhu NK. CT imaging patterns of paraduodenal pancreatitis: a unique clinicoradiological entity. Clin Radiol 2022; 77:e613-e619. [PMID: 35589430 DOI: 10.1016/j.crad.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/14/2022] [Indexed: 12/19/2022]
Abstract
AIM To analyse the computed tomography (CT) findings of paraduodenal pancreatitis (PP) in patients treated at Amrita Institute of Medical Sciences. MATERIALS AND METHODS Clinical, laboratory, and CT findings of 30 patients with PP treated from July 2007 to December 2020 were reviewed retrospectively. RESULTS The average age of the patients was 45.9 years (19-60 years), which included 29 (96.7%) men, and 90% had a history of alcohol abuse. The majority [22 (73.3%)] presented with recurrent abdominal pain. Serum amylase was elevated in 21 (70%) patients and serum lipase was elevated in 25 (83.3%) patients. Carbohydrate antigen (CA 19-9) was elevated in three (10%) patients. The cystic pattern was seen in three (10%), solid pattern in 13 (43.3%), and solid-cystic pattern in 14 (46.7%) patients. The pure form of the disease was seen in seven (23.3%) patients, whereas the segmental form was seen in 23 (76.7%) patients. Descending duodenal wall thickening and enhancement was seen in 25 (83.3%) and 18 (60%) patients, respectively. The gastroduodenal artery was displaced medially in 12 (40%) patients and encased in five (16.7%) patients; however, it was not occluded in any of the patients. Calcifications were seen in the groove lesion in nine (30%) patients. The pancreas showed atrophic changes in 14 (46.6%) patients and calcifications in 12 (40%) patients. Distal common bile duct strictures were seen in three (10%) patients. CONCLUSIONS The presence of sheet-like soft-tissue thickening in the groove with diffuse duodenal thickening and intramural/paraduodenal cysts are highly suggestive of PP. Identifying characteristic imaging findings of PP may help in prospective diagnosis and lead to conservative management of most of these patients avoiding unnecessary invasive procedures.
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Affiliation(s)
- C B Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala state, India.
| | - S Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala state, India
| | - S K Pullara
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala state, India
| | - N K Prabhu
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala state, India
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Issa Y, van Santvoort HC, van Dieren S, Besselink MG, Boermeester MA, Ahmed Ali U. Diagnosing Chronic Pancreatitis: Comparison and Evaluation of Different Diagnostic Tools. Pancreas 2017; 46:1158-1164. [PMID: 28902786 DOI: 10.1097/mpa.0000000000000903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aims to compare the M-ANNHEIM, Büchler, and Lüneburg diagnostic tools for chronic pancreatitis (CP). METHODS A cross-sectional analysis of the development of CP was performed in a prospectively collected multicenter cohort including 669 patients after a first episode of acute pancreatitis. We compared the individual components of the M-ANNHEIM, Büchler, and Lüneburg tools, the agreement between tools, and estimated diagnostic accuracy using Bayesian latent-class analysis. RESULTS A total of 669 patients with acute pancreatitis followed-up for a median period of 57 (interquartile range, 42-70) months were included. Chronic pancreatitis was diagnosed in 50 patients (7%), 59 patients (9%), and 61 patients (9%) by the M-ANNHEIM, Lüneburg, and Büchler tools, respectively. The overall agreement between these tools was substantial (κ = 0.75). Differences between the tools regarding the following criteria led to significant changes in the total number of diagnoses of CP: abdominal pain, recurrent pancreatitis, moderate to marked ductal lesions, endocrine and exocrine insufficiency, pancreatic calcifications, and pancreatic pseudocysts. The Büchler tool had the highest sensitivity (94%), followed by the M-ANNHEIM (87%), and finally the Lüneburg tool (81%). CONCLUSIONS Differences between diagnostic tools for CP are mainly attributed to presence of clinical symptoms, endocrine insufficiency, and certain morphological complications.
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Affiliation(s)
- Yama Issa
- From the *Department of Surgery, Academic Medical Center, Amsterdam; †Department of Surgery, St Antonius Hospital, Nieuwegein; and ‡Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Di Serafino M, Severino R, Brigida R, Scarano E. Cystic dystrophy of the duodenal wall in heterotopic pancreas: an atypical case in non-alcoholic female. BJR Case Rep 2016; 2:20160058. [PMID: 30460038 PMCID: PMC6243317 DOI: 10.1259/bjrcr.20160058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/16/2016] [Accepted: 05/11/2016] [Indexed: 12/14/2022] Open
Abstract
Cystic dystrophy of the duodenal wall in heterotopic pancreas, recently described as paraduodenal pancreatitis, is a rare condition characterized by multiple cysts or pseudocysts located in the submucosa or muscularis propria of a thickened duodenal wall. They result from multiple episodes of obstruction of the small ducts in aberrant pancreatic islets. Cystic dystrophy of the duodenal wall in heterotopic pancreas usually affects alcoholic males, but here we present the case of a female without a history of alcohol abuse who was referred to our emergency department with abdominal pain and vomiting. She was treated by a pancreas-preserving surgical approach, thanks to a proper pre-operative differential diagnosis. Even though differentiating this benign condition from pancreatic cancer is a challenge, some characteristic findings on multidetector CT scan and MRI/MR cholangiopancreatography, such as a thickened duodenal wall containing cysts and sheet-like tissues in the pancreaticoduodenal groove, could lead to the correct diagnosis.
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Affiliation(s)
| | - Rosa Severino
- Radiology Department, Federico II University Hospital, Napoli, Italy
| | - Raffaela Brigida
- Emergency Radiology Department, San Carlo Hospital, Potenza, Italy
| | - Enrico Scarano
- Emergency Radiology Department, San Carlo Hospital, Potenza, Italy
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Lekkerkerker SJ, Nio CY, Issa Y, Fockens P, Verheij J, Busch OR, van Gulik TM, Rauws EA, Boermeester MA, van Hooft JE, Besselink MG. Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis. J Gastroenterol Hepatol 2016; 31:1895-1900. [PMID: 26997497 DOI: 10.1111/jgh.13376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Data on non-surgical treatment of groove pancreatitis (GP) and the risk of cancer are lacking. We aimed to determine the prevalence and predictors of cancer in patients in whom the diagnosis GP was considered, and to evaluate symptom improvement after treatment. STUDY Patients referred with possible GP (2001-2014) were retrospectively included. An experienced radiologist reassessed imaging. GP patients received questionnaires evaluating their symptoms. RESULTS From the 38 possible GP patients, 10 had cancer (26%) and 28 GP (74%). Compared with cancer patients, GP patients more frequently had cysts (2/10 vs. 18/28, P = 0.03), less often jaundice (6/10 vs 3/27, P < 0.01), an abrupt caliber change of the CBD (5/10 vs. 2/28, P < 0.01) or suspicious cytology (5/9 vs 2/20, P = 0.02). Of the 28 GP patients, 14 patients were treated conservatively of whom 12 reported symptom improvement after a median follow-up of 45 months (range 7-127 months). All 6 patients treated endoscopically and 7/8 patients treated surgically reported symptom improvement. Surgery, performed because of treatment failure (3/8) or inability to exclude malignancy (5/8), caused mortality in 1/8 patients. CONCLUSIONS Suspicion of pancreatic cancer should be high in patients presenting with possible GP. Conservative, endoscopic and surgical treatment can all lead to symptom improvement, suggesting a 'step-up approach' to GP once cancer is excluded.
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Affiliation(s)
- Selma J Lekkerkerker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Chung Y Nio
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yama Issa
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joanne Verheij
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik A Rauws
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Brosens LAA, Leguit RJ, Vleggaar FP, Veldhuis WB, van Leeuwen MS, Offerhaus GJA. EUS-guided FNA cytology diagnosis of paraduodenal pancreatitis (groove pancreatitis) with numerous giant cells: conservative management allowed by cytological and radiological correlation. Cytopathology 2014; 26:122-5. [DOI: 10.1111/cyt.12140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 01/29/2023]
Affiliation(s)
- L. A. A. Brosens
- Department of Pathology; Academic Medical Center Amsterdam; Amsterdam the Netherlands
| | - R. J. Leguit
- Department of Pathology; University Medical Center Utrecht; Utrecht the Netherlands
| | - F. P. Vleggaar
- Department of Gastroenterology and Hepatology; University Medical Center Utrecht; Utrecht the Netherlands
| | - W. B. Veldhuis
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - M. S. van Leeuwen
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - G. J. A. Offerhaus
- Department of Pathology; University Medical Center Utrecht; Utrecht the Netherlands
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Arora A, Dev A, Mukund A, Patidar Y, Bhatia V, Sarin SK. Paraduodenal pancreatitis. Clin Radiol 2013; 69:299-306. [PMID: 24094726 DOI: 10.1016/j.crad.2013.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/26/2013] [Accepted: 07/10/2013] [Indexed: 01/14/2023]
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.
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Affiliation(s)
- A Arora
- Department of Radiology, Institute of Liver and Biliary Sciences, Delhi, India.
| | - A Dev
- Department of Radiology, Institute of Liver and Biliary Sciences, Delhi, India
| | - A Mukund
- Department of Radiology, Institute of Liver and Biliary Sciences, Delhi, India
| | - Y Patidar
- Department of Radiology, Institute of Liver and Biliary Sciences, Delhi, India
| | - V Bhatia
- Department of Hepatology and Gastroenterology, Institute of Liver and Biliary Sciences, Delhi, India
| | - S K Sarin
- Department of Hepatology and Gastroenterology, Institute of Liver and Biliary Sciences, Delhi, India
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