Re: Heterotopic Pancreatitis with Obstruction of the Major Duodenal Papilla

Abstract

use it to confi rm a diagnosis initially suggested by CT. Histology confi rmed in each case the infl ammatory nature of the changes involving the duodenal wall and pancreaticoduodenal interface, and the presence of infl amed, cystically dilated ducts of ectopic pancreatic tissue within the periampullary duodenal wall. Patients presented with abdominal pain, which had often existed for several years, and symptoms related to duodenal obstruction. Obstructive jaundice has been reported to occur in 10–20% of cases [1, 5] . Alcohol is discussed as an important, albeit not exclusive, pathogenetic factor, as more than 60% of patients have a history of high alcohol intake [7] . We assume the authors are aware of this condition known as ‘groove pancreatitis’ and would be interested to know how they believe their case differs and deserves recognition as a separate entity. We read with great interest the case report of Obermaier et al. which they coined as ‘Heterotopic pancreatitis with obstruction of the major duodenal papilla’ (Pancreatology 2004; 4: 244–248). Infl ammation of the duodenal wall and adjacent pancreatic tissue secondary to cystic dilatation and infl ammation of ectopic pancreatic tissue in the periampullary duodenum has been described previously in the literature as cystic dystrophy of the duodenal wall in heterotopic pancreas [1] or groove pancreatitis [2] . This condition is not infrequent, its incidence being reported as representing 11–24% of pancreaticoduodenectomies [3, 4] . Our own series of 8 cases [unpubl. data] had similar features, as in the case report by Obermaier et al. We classifi ed these as ‘groove pancreatitis’ in keeping with the data from literature. Preoperative diagnosis was established in 5 cases based on characteristic CT and endoscopic ultrasound fi ndings [5, 6] . CT typically demonstrated signifi cant soft tissue thickening, with or without cystic change, involving the medial wall of duodenum and the interface between duodenum and pancreas. Not infrequently, the fi ndings in the pancreatic head itself were fairly unremarkable. We have found endoscopic ultrasound to be a superb technique for demonstrating the cystic changes in the duodenal wall and Published online: August 17, 2005