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2015 ; 7
(11
): 529-32
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English Wikipedia
Groove Pancreatitis: A Rare form of Chronic Pancreatitis
#MMPMID26713302
Jani B
; Rzouq F
; Saligram S
; Nawabi A
; Nicola M
; Dennis K
; Ernst C
; Abbaszadeh A
; Bonino J
; Olyaee M
N Am J Med Sci
2015[Nov]; 7
(11
): 529-32
PMID26713302
show ga
CONTEXT: Groove pancreatitis is a rare form of chronic pancreatitis affecting the
"groove" of the pancreas among the pancreatic head, duodenum, and common bile
duct. The exact cause is unknown, although there are associations with long-term
alcohol abuse, smoking, peptic ulcer disease, heterotopic pancreas, gastric
resection, biliary disease, and anatomical or functional obstruction of the minor
papilla. The diagnosis can be challenging. Endoscopic ultrasound (EUS) and
magnetic resonance cholangiopancreatography are the preferred imaging modalities.
The treatment of choice is conservative although surgical intervention can
sometimes be required. CASE REPORT: A 57-year-old male with a history of human
immunodeficiency virus and hepatitis B presented with 4 days of epigastric pain.
Abdominal exam revealed absent bowel sounds and epigastric tenderness. He had a
creatinine of 1.72 mg/dL, potassium of 2.9 mmol/L, and a normal lipase level of
86 U/L. Liver enzymes and total bilirubin were normal. Computed tomography
abdomen showed high-grade obstruction of the second portion of the duodenum
without any obvious mass. An esophagogastroduodenoscopy showed a mass at the
duodenal bulb causing luminal narrowing, with biopsies negative for malignancy.
Magnetic resonance imaging revealed a mass in the region of the pancreatic head
and descending duodenum. EUS revealed a 3 cm mass in the region of pancreatic
head with irregular borders and no vascular invasion. Fine needle aspiration
(FNA) was nondiagnostic. The patient then underwent a Whipple's procedure.
Pathology of these specimens was negative for malignancy but was consistent with
para-duodenal or groove pancreatitis. CONCLUSION: The low incidence of groove
pancreatitis is partly due to lack of familiarity with the disease. Groove
pancreatitis should be considered in the differential for patients presenting
with pancreatic head lesions and no cholestatic jaundice, especially when a
duodenal obstruction is present, and neither duodenal biopsies nor pancreatic
head FNA confirm adenocarcinoma.