1369 Not Feeling so Groovy: A Case of Groove Pancreatitis

Abstract

INTRODUCTION: Groove pancreatitis is a rare form of chronic segmental pancreatitis that affects the anatomical area between the pancreatic head, duodenum, and common bile duct. Definitive etiology is unknown, however, it predominantly affects males 40 to 50 years of age with a significant alcohol use history. Groove pancreatitis is an important diagnosis to consider in the evaluation of pancreatic head lesions. CASE DESCRIPTION/METHODS: A 35-year-old male with past medical history significant for chronic pancreatitis and alcohol use disorder presented with complaint of acute-onset epigastric abdominal pain with associated nausea and vomiting. He reported that his last use of alcohol was three weeks prior to presentation. Laboratory studies were significant for elevated lipase at 1,591 IU/L and normal liver enzymes. CT abdomen and pelvis demonstrated an enlarged peripancreatic fluid collection between the uncinate process and horizontal portion of the duodenum. The horizontal portion of the duodenum was narrowed secondary to mass effect from the peripancreatic fluid collection. MRI with MRCP revealed fluid collections interposed between the pancreatic head and third portion of the duodenum. EGD with endoscopic ultrasound was performed and showed induration and edema of the second portion of the duodenum and anechoic cysts present in the duodenal wall. Biopsies were obtained during EUS via FNA and were negative for pancreatic adenocarcinoma. Together, these findings were consistent with a diagnosis of groove pancreatitis. The patient clinically improved with conservative medical management: fluid resuscitation, analgesia, antiemetics, and pancreatic enzyme supplementation. DISCUSSION: Groove pancreatitis is characterized by fibrosis in the “groove” area between the pancreatic head, duodenum, and common bile duct. Characteristic findings include cystic lesions in the duodenal wall and duodenal stenosis. It poses a challenge to clinicians, as its presentation may be similar to that of pancreatic adenocarcinoma. It is important for clinicians to be aware of this disease entity and consider it in evaluation of pancreatic head lesions.