Could it be groove pancreatitis? A frequently misdiagnosed condition with a surgical solution

Abstract

Background: Groove pancreatitis (GP) is an underrecognised subtype of chronic pancreatitis, focally affecting the area between the duodenum and pancreatic head. It most commonly affects males between 40 and 50 years of age with a history of alcohol misuse. Patients most commonly complain of abdominal pain and vomiting. Due to its focal nature, it is a potentially surgically treatable form of chronic pancreatitis. We report results of patients surgically treated for groove pancreatitis followed by a literature review of patient outcomes post resection.

Methods: A retrospective chart review of patients with histopathologically confirmed GP post-surgical resection at the Princess Alexandra Hospital and Greenslopes Private Hospital in Brisbane, Australia was conducted between 2013 and 2020. Diagnosis was confirmed histologically when Brunner gland hyperplasia and chronic inflammation/fibrosis were found within the pancreaticoduodenal interface. Preoperative and postoperative symptoms were analysed along with complications. Additionally, a systematic review on outcomes of patients undergoing pancreaticoduodenectomy (PD) for GP was performed from three databases.

Results: Eight patients underwent surgery for GP. Elimination of preoperative symptoms was achieved in five of the eight patients. Major complications included one take back to theatre for pancreatic leak. Our literature review found complete resolution of pain and vomiting in 80% of GP patients after PD.

Conclusion: Optimal management of GP begins with early recognition. Symptoms from GP are likely to respond well to surgical intervention. We advocate for aggressive surgical resection in a patient with a high index of suspicion for GP.

Keywords: groove; pancreaticoduodenectomy; pancreatitis; paraduodenal; whipples.

Fig. 1

Marked fibrocystic change in the groove between the pancreas and the duodenum associated with acute inflammation and abscess formation. There is florid Brunner gland hyperplasia and duodenitis. Courtesy of envoi pathology.

Fig. 2

Thickening of the second and third part of the duodenum (arrows) associated with gastric outlet obstruction.

Fig. 3

Axial CT image of groove pancreatitis with paraduodenal cysts and chronic calcific changes in the pancreatic head.