“Duodenal dystrophy”, or “groove pancreatitis”, or “paraduodenal pancreatitis?” Does it matter which name you choose? Lessons of 76 cases

Abstract

Background: The term “paraduodenal pancreatitis (PP)“ was proposed as an umbrella for cystic dystrophy in heterotopic pancreas (duodenal dystrophy,DD), paraduodenal cyst and groove pancreatitis, by reasoning that these conditions mimic pancreatic head tumors and share certain histological evidences. The reasons for amalgamation of these terms are unclear. Methods: Prospective analysis of 76 cases of DD (2004-2016), comparing 65 preoperative and 57 histopathological findings; Assessment of clinical presentation and the results of DD treatment. Results: Preoperative diagnosis was correct in all cases except one (1,9%). Patients were presented with abdominal pain(100%), weight loss(76%), vomiting(30%) and jaundice(18%). CT, MRI and endoUS were the most useful diagnostic modalities. Nine patients were treated conservatively, 35 underwent pancreaticoduodenectomies(PD), pancreatico- and cystoenterostomies(8), Nakao procedures(4), duodenum-preserving pancreatic head (DPPH) resections(5), and 14 pancreas-preserving duodenal resections(PPDR). No mortality. Full pain control was achieved after PPRDs in 93%, PDs in 83%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD. In 3 PD cases only moderate pancreatitis was revealed in specimen Conclusion: The diagnosis of DD can be confidently determined by modern methods preoperatively;Early diagnosis of DD saves pancreas The efficacy of PPDR proves DD is an entity of duodenal, but not paraduodenal origin