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Case Reports
. 2019 Dec 6;7(23):4106-4110.
doi: 10.12998/wjcc.v7.i23.4106.

Complete duodenal obstruction induced by groove pancreatitis: A case report

Ya-Li Wang  1 , Chen-Hao Tong  1 , Jian-Hua Yu  1 , Zhi-Liang Chen  1 , Hong Fu  1 , Jian-Hui Yang  1 , Xin Zhu  1 , Bao-Chun Lu  2
Affiliations
Case Reports

Complete duodenal obstruction induced by groove pancreatitis: A case report

Ya-Li Wang et al. World J Clin Cases. .

Abstract

Background: Groove pancreatitis (GP) is a type of chronic pancreatitis occurring in an anatomic area between the duodenum, head of the pancreas, and common bile duct. Duodenal obstruction is always caused by malignant pancreatic diseases, such as pancreatic head carcinoma, while is rarely induced by benign pancreatic diseases, such as pancreatitis.

Case summary: A 39-year-old man presented with a 1-mo history of upper abdominal discomfort. His concomitant symptoms were abdominal distension, postprandial nausea, and vomiting. Contrast-enhanced computed tomography of the abdomen showed thickening of the intestinal wall with enhancement of the descending segment of the duodenum, which could not be clearly differentiated from the head of the pancreas. Upper gastrointestinal radiographs and gastrointestinal endoscopy showed a complete obstruction of the descending duodenum. An operation found that a 3-cm mass was located in the "groove part" of the pancreas and oppressing the descending duodenum. Pancreaticoduodenectomy was performed to relieve the obstruction and thoroughly remove the pancreatic lesions. The pathologic diagnosis was pancreatitis. The patient had an uneventful recovery with no complications.

Conclusion: Because of the special location and the contracture induced by long-term chronic inflammation, our case reminds surgeons that some benign pancreatic diseases, such as GP, can also present with symptoms similar to those of pancreatic cancer. This knowledge can help to avoid an unnecessary radical operation.

Keywords: Case report; Duodenal obstruction; Groove pancreatitis; Pancreatic head carcinoma.

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Conflict of interest statement

Conflict-of-interest statement: There are some conflicts in funding. Authors obtained the grant support from National Natural Science Foundation of China; Zhejiang Provincial Natural Science Foundation of China; Zhejiang Provincial Public Welfare Technology Application Research Projects; and Research Foundation of Health Bureau of Zhejiang Province.

Figures

Figure 1
Figure 1
Contrast-enhanced computed tomography image and upper gastrointestinal radiograph. A: Contrast-enhanced computed tomography image of the lesion. Red arrow: Thickened and obstructed duodenum (the lesion looks like an increased fat tissue concentration around the duodenum); yellow arrow: Pancreaticoduodenal groove; blue arrow: Dilated pancreatic duct; B: Upper gastrointestinal radiograph showing that there was no contrast agent entering the descending duodenum.
Figure 2
Figure 2
Duodenoscopy and histopathological examination. A: Duodenoscopic image showing complete obstruction of the descending duodenum (white arrow); B: Histopathological examination showing fibrous proliferation and chronic inflammation in the groove area. (Hematoxylin and eosin staining; magnification, 20×).
See this image and copyright information in PMC

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