Diagnosis Of Groove Pancreatitis Research Articles

Groove pancreatitis: From enigma to future directions-A comprehensive review.

Groove pancreatitis (GP) is a rare and clinically distinct form of chronic pancreatitis affecting the pancreaticoduodenal groove comprising the head of the pancreas, duodenum, and the common bile duct. It is more prevalent in individuals in their 4-5th decade of life and disproportionately affects men compared with women. Excessive alcohol consumption, tobacco smoking, pancreatic ductal stones, pancreatic divisum, annular pancreas, ectopic pancreas, duodenal wall thickening, and peptic ulcers are significant risk factors implicated in the development of GP. The usual presenting symptoms include severe abdominal pain, nausea, vomiting, diarrhea, weight loss, and jaundice. Establishing a diagnosis of GP is often challenging due to significant clinical and radiological overlap with numerous benign and malignant conditions affecting the same anatomical location. This can lead to a delay in initiation of treatment leading to increasing morbidity, mortality, and complication rates. Promising research in artificial intelligence (AI) has garnered immense interest in recent years. Due to its widespread application in diagnostic imaging with a high degree of sensitivity and specificity, AI has the potential of becoming a vital tool in differentiating GP from pancreatic malignancies, thereby preventing a missed or delayed diagnosis. In this article, we provide a comprehensive review of GP, covering the etiology, pathogenesis, clinical presentation, radiological and endoscopic evaluation, management strategies, and future directions. This article also aims to increase awareness about this lesser known and often-misdiagnosed clinical entity amongst clinicians to ultimately improve patient outcomes.

Study of role of computerized tomography (CT) in evaluation of groove pancreatitis

Background: Groove pancreatitis is a rare form of chronic pancreatitis affecting the groove between the pancreatic head, duodenum and common bile duct. The exact cause of the disease is not known, although there are strong associations with long term alcohol abuse, functional obstruction of duct of Santorini and brunner gland hyperplasia. The purpose of this study was to describe the imaging findings of groove pancreatitis (GP) on Contrast enhanced CT Abdomen. Material and Methods: Present study was retrospective study conducted, with help of medical records of 16 patients with a final diagnosis of Groove pancreatitis. CT, MRI and MRCP findings were analysed. Statistical analysis was done using descriptive statistics. Results: In present study, two types of groove pancreatitis (GP) as pure type (50%) and segmental type (50%) were noted. Other important findings were focal duodenal wall thickening (62.5%) and cysts in the duodenal wall itself or in groove between the pancreatic head and the duodenum (37.5%), CBD dilatation and distal smooth tapering (62.5%) including all the segmental types and 2 of the pure type leading to intra- and extra-hepatic biliary system dilatation. MRI and MRCP were available in 6 patients in our study. There was a CT similarity regarding the sheet of tissues within the pancreaticoduodenal groove. These were seen expressing T1 hypo-intense and T2 slightly hyperintense signal in 3 patients with depiction of mild enhancement in the delayed phases in three of them (50%). On the MDCT examinations hypodense sheet at the PD groove was seen in 12 patients with modest enhancement identified in delayed phase seen in 6 of the them. Duodenal wall thickening was seen in 10 patients while associated cysts within the duodenal wall or in PD groove were seen in 6 patients. Pancreatic head enlargement with diffuse enhancement was seen in 8 patients. Mild pancreatic duct dilatation was seen in 8 patients while dilatation of the CBD was seen in 10 patients with distal tapering and intra-hepatic biliary dilatation. Conclusion: Groove pancreatitis (GP) is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall. Imaging findings that are suggestive of GP include chronic inflammatory changes with fibrosis in the PD groove with or without implication of the nearby head of the pancreas, duodenal medial mural thickening with luminal stenosis and cysts at the PD groove or within the duodenal wall.

1369 Not Feeling so Groovy: A Case of Groove Pancreatitis

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.

Groove Pancreatitis: Report of Three Cases with Brief Review of Literature.

Groove pancreatitis (GP) is a rare type of segmental pancreatitis, and it remains largely an unfamiliar entity to most physicians. It is often misdiagnosed as pancreatic cancer and autoimmune pancreatitis. With better understanding of radiological findings, preoperative differentiation is often possible. If there is preoperative diagnosis of GP, one can employ non-surgical treatment. But most of the patients ultimately require surgery. Pancreaticoduodenectomy (PD) is the surgical treatment of choice. We report three cases of GP that were treated by Whipple's operation at our unit. All the three patients had a history of long-standing alcohol intake. In the first and third patients, we had a preoperative diagnosis of GP. But, in the second patient, our pre-operative and intra-operative diagnosis was a pancreatic head malignancy. Diagnosis of GP was made only after histopathological examination. All the three patients had uneventful postoperative recovery and were well at 55-, 45- and 24-month follow-up respectively. In addition to detail descriptions of our three cases, a detailed review of the current literature surrounding this clinical entity is also provided in this article.

Misdiagnosis of Groove Pancreatitis: A Case Report

Groove Pancreatitis (GP) is a kind of chronic pancreatitis with a clear pathological diagnosis. It’s characterized by fibrotic scarring of the gastroduodenal groove, an anatomical area near the pancreatic head, duodenum and common bile duct (CBD). Its etiology is not clear. GP may be related to alcoholism, weight loss, biliary tract disease, pancreatic cysts and so on. Its incidence rate of GP is low and the diagnosis is difficult. The purpose of this essay is to report a case of GP. A 56-year-old woman is admitted to hospital with painless systemic jaundice as her only symptom and the symptom aggravated in two months. Both medical imagology (CT, MR, and MRCP) and serologic examination (cancer antigens (CA) 19-9) support the diagnosis of malignant cholangiocarcinoma; but, the results of electronic gastroscopy were basically normal. Surgeons had found no malignant tumor characteristics (irregular shape, adhesion, necrosis and so on) in the operation. However, Postoperative pathological results verified the intraoperative evaluation. Combined with postoperative pathological results, the surgeon's experience and reported in domestic and foreign literature, operators consider the patient should be diagnosed as GP. Making a definite diagnosis of GP requires a comprehensive analysis on discriminating with another disease like CBD carcinoma and pancreatic head carcinoma to prevent an over-treatment of patient.

Groove pancreatitis: Imaging features and management

The aim of this retrospective study was to highlight the imaging findings of groove pancreatitis (GP) as well as its management. Patients and methods16 patients diagnosed to have GP were enrolled in this work. The included patients had complete records of the thorough clinical examination and laboratory workup. All patients had been examined by multi-phase contrast enhanced MDCT tailored for pancreatic imaging. Six of these patients were additionally examined by MRI including MRCP., ResultsMDCT Multiple detector computed tomography of the 16 patients revealedthe following: (1) a hypodense sheet in the pancreaticoduodenal (PD) groove seen in 12 patients with mild enhancement in the delayed phase seen in 6 of the them; (2) Duodenal wall thickening was seen in 10 patients while (3) associated cysts within the duodenal wall or in PD groove were seen in 6 patients; (4) and pancreatic head enlargement in 8 patients. MRI of Six patients revealedthe following: (1) a T1 hypointense and T2 iso to hyperintense sheet at the PD groove in 4 patients with delayed enhancement in 3 of them; (2) Duodenal wall thickening with T2 high signal was seen in 6 patients while associated cysts within the duodenal wall were seen in 4 patients; (3) Pancreatic head enlargement seen in 4 patients; The MRCP of these patients showed dilated CBD with distal tapering and a distance separating its end from the duodenal wall. ConclusionGP is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall. Imaging findings that are suggestive of GP include chronic inflammatory changes with fibrosis in the PD groove with or without implication of the nearby head of the pancreas, duodenal medial mural thickening with luminal stenosis and cysts at the PD groove or within the duodenal wall. Vascular invasion is a sign against diagnosis of GP.

A Not-So-Groovy Masquerader: A Case Report of Groove Pancreatitis

Background: Groove pancreatitis is an uncommon and under-recognized form of focal chronic pancreatitis of the area between the pancreatic head and duodenum due to obstruction of pancreatic juice flow in the minor duct. This disease entity creates a diagnostic challenge as clinical, radiographic, and gross pathologic features can mimic pancreatic adenocarcinoma. Case: A 54-year-old male former-smoker with a history of chronic alcohol consumption presented initially with refractory pyrosis and nausea. Esophagogastroduodenoscopy (EGD) demonstrated duodenal wall thickening and a CT scan of his abdomen revealed duodenitis and inflammation of the pancreatic head with fat stranding. He re-presented three years later with worsening epigastric pain and a 60 pound weight loss. Repeat CT scan revealed an infiltrating heterogeneously enhancing process between the descending duodenum and pancreatic head (Figure 1). Magnetic resonance cholangiopancreatography (MRCP) revealed a 2.7 x 2.3 x 2.3cm mass with soft tissue infiltration and narrowing of the distal common bile duct (CBD) concerning for possible malignancy. CA 19-9 and liver function tests were within normal limits. Continued abdominal pain, intolerance to oral intake, persistent nausea and vomiting, and continued weight loss lead to endoscopic ultrasound (EUS). This demonstrated diffuse pancreatic head and genu parenchymal abnormalities, a 10mm CBD, and enlarged peripancreatic lymph nodes. Repeat MRCP on subsequent admission again revealed focal groove-centric changes of acute and chronic pancreatitis with duodenal wall thickening. EGD/EUS with duodenal biopsies demonstrated focal duodenitis with prominent Brunner glands and fine needle aspiration of the mass revealed cellular atypia and chronic inflammation consistent with chronic pancreatitis and a diagnosis of groove pancreatitis was established.Figure 1Discussion: Groove pancreatitis poses a diagnostic challenge due to its malignancy-like presentation and clinical course. Many of the described risk factors and classical findings of groove pancreatitis were present in our patient including chronic tobacco and alcohol use, severe weight loss secondary to duodenal stenosis, sheet-like mass lesion in the periduodenal space, and prolonged time to diagnosis. However, his clinical course demonstrates the complex nature of this disease process, the close resemblance to pancreatic malignancy, and the difficulty in differentiating these two conditions to arrive at a diagnosis.

Groove Pancreatitis or Pancreatic Neoplasm: A Surgical Dilemmas

Background: Groove pancreatitis (GP) is a rare condition characterized by inflammatory fibrosis of the space between the dorsal-cranial part of the head of the pancreas, duodenum and common bile duct. Surgery is often the choice of treatment. Case report: A 44-year-old male patient with a history of a high alcoholic intake came with epigastric pain associated with a weight loss. An abdominal ultrasonography, a computer tomography (CT) and a gastro-duodenoscopy showed a mass of the pancreatic head with duodenal infiltration suggesting for adenocarcinoma of the pancreas. An endoscopic ultrasound - fine needle aspiration (EUS-FNA) did not show any sign of chronic inflammation. The patient underwent Whipple procedure. Histologic examination confirmed chronic inflammation in the groove area with a ruptured pancreatic-type cyst and some pseudocysts in depth of the wall. Conclusion: The diagnosis of GP is challenging. Radiological and endoscopic findings and symptoms are often not specific and they could also be present in patients with adenocarcinoma of the pancreas. The pancreaticoduodenectomy is often the choice of treatment when symptoms do not improve or when there is uncertainty over the diagnosis.

Groove (paraduodenal) pancreatitis: Report of two cases

"Groove" pancreatitis is a rare segmental form of chronic pancreatitis that involves the area located between the common bile duct, head of the pancreas and duodenum. It is more common in middle-aged males who have a history of alcohol abuse. The differential diagnosis varies from anatomic variants to malignancies. The most relevant differential diagnosis of groove pancreatitis is adenocarcinoma of the head of the pancreas. Most of the cases were diagnosed after pancreatic resection. Thus, the correct diagnosis of this rarely seen disease is very important to avoid unnecessary tests or procedures and to determine the definitive treatment.

Groove pancreatitis: A case series and review of the literature

Groove pancreatitis is a form of chronic pancreatitis affecting the space surrounded by the pancreatic head, duodenum and common bile duct. The clinical findings can conflict with pancreatic cancer causing diagnostic dilemma preoperatively. We describe two patients with a history of alcohol excess, who presented with a few months history of upper abdominal pain associated with weight loss and vomiting. Endoscopic and radiological investigations related duodenal narrowing, biliary dilatation and multiple pseudocysts around the head of the pancreas and duodenum. A Whipple's pancreaticoduodenectomy was carried out in both patients. Histopathology report demonstrated cystic areas in both medial and lateral walls of the duodenum microscopically consistent with groove pancreatitis. The diagnosis of groove pancreatitis should be considered in patients with duodenal stenosis and cystic lesions around the head of the pancreas associated with history of alcohol excess. Differentiation from pancreatic cancer is difficult preoperatively.

Cystic dystrophy of heterotopic pancreas in duodenal wall

Cystic dystrophy in heterotopic pancreas is a rare, poorly understood benign disease of gastric and duodenal wall, which was described for the first time by the French authors in 1970, who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of duodenum & the head of pancreas. We report a case of 33 years old male patient with complaint of recurrent abdominal pain with the probable diagnosis of groove pancreatitis on the clinoradiological findings. Whipple surgery was done. Diagnosis of cystic dystrophy in heterotopic pancreas in duodenal wall with chronic pancreatitis was given histopathologically.

Groove pancreatitis: MRI and pathologic findings

Our purpose is to describe the MRI findings with pathologic correlation, in five patients with groove pancreatitis, a specific form of chronic pancreatitis affecting the groove between the pancreatic head, the common bile duct and duodenum. Five patients with pathologically proven (four cases) and clinical and MRI findings (follow-up) consistent with the diagnosis of groove pancreatitis (one case) were reviewed. Three patients underwent cephalic pancreatoduodenectomy (Whipple procedure) due to severe duodenal stenosis; MRI findings were correlated with the histological findings. In all patients a mass was seen affecting the groove between the pancreatic head and the duodenum. Precontrast images demonstrated hypointense tissue relative to pancreatic parenchyma on T1-weighted images and iso to slightly hyperintense tissue on STIR and T2-weighted images. Postcontrast dynamic Gd-DTPA images, showed peripheral mass enhancement on immediate postgadolinium images and progressive and centripetal mass enhancement on delayed images with good delineation of multiple cysts. Histologically, fibro-inflammatory tissue was demonstrated in the groove and the duodenal wall with obliterative concentric scarring of the distal common bile duct. MRI findings are demonstrative of the pathologic features characteristic of this entity: the fibrous tissue in the pancreaticoduodenal groove, the duodenal wall inflammation and the groove and/or duodenal wall cyst formation.

Groove pancreatitis with recurrent duodenal obstruction

Groove pancreatitis is a rare subtype of chronic pancreatitis that is difficult to distinguish from pancreatic carcinoma. Most reported patients have undergone a Whipple procedure because pancreatic cancer was not ruled out. We report a case of groove pancreatitis in a patient who presented with recurrent duodenal obstruction without biliary stricture. The diagnosis of groove pancreatitis was based on characteristic episodes of repeated duodenal obstruction and the absence of radiographic evidence of cancer. Subsequently, our patient underwent a successful pylorus-preserving pancreaticoduodenectomy (PPPD). PPPD is a favorable alternative to the Whipple operation for duodenal obstruction resulting from this disease.