Characteristic clinical and pathologic features for preoperative diagnosed groove pancreatitis

Abstract

Purpose: Groove pancreatitis is a rare specific form of chronic pancreatitis that extends into the anatomical area between the pancreatic head, the duodenum, and the common bile duct, which are referred to as the groove areas. We present the diagnostic modalities, pathological features and clinical outcomes of a series of symptomatic patients with groove pancreatitis who underwent pancreaticoduodenectomy.

Methods: Six patients undergoing pancreaticoduodenectomy between May 2006 and May 2009 due to a clinical diagnosis of symptomatic groove pancreatitis were retrospectively included in the study.

Results: Five cases were male and one case was female, with a median age at diagnosis of 50 years. Their chief complaints were abdominal pain and vomiting. Abdominal computed tomography, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography were performed. Preoperative diagnosis of all patients was groove pancreatitis. Histological finding was compatible with clinically diagnosed groove pancreatitis in five patients and the pathologic diagnosis of the remaining patient was adenocarcinoma of distal common bile duct. Following pancreaticoduodenectomy, four living patients experienced significant pain alleviation.

Conclusion: The diagnostic imaging modalities of choice for groove pancreatitis are computed tomography and endoscopic ultrasonography. If symptomatic groove pancreatitis is suspected, careful follow-up of patients is necessary and pancreaticoduodenectomy seems to be a reasonable treatment option.

Keywords: Chronic disease; Pancreatic cancer; Pancreaticoduodenal groove; Pancreaticoduodenectomy; Pancreatitis.

Fig. 1

Computed tomography reveals typical cystic and mass-like lesions in head of pancreas at interface with duodenum.

Fig. 2

Computed tomography (A) and endoscopy (B) are compatible with groove pancreatitis, but patient's pathologic diagnosis was distal common bile duct cholangiocarcinoma.

Fig. 3

Gross findings. A specific form of chronic pancreatitis that extended into anatomical area between pancreatic head, duodenum, and common bile duct is shown.

Fig. 4

Acute inflammation of groove area is shown in histologic examination of 17-year-old male (H&E, ×40).