Cystic dystrophy of the duodenal wall is not always associated with chronic pancreatitis

Abstract

Cystic dystrophy of the duodenal wall is a rare form of the disease which was described in 1970 by French authors who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of the duodenum and the head of the pancreas. German authors have defined this area as a "groove". We report our recent experience on cystic dystrophy of the paraduodenal space and systematically review the data in the literature regarding the alterations of this space. A MEDLINE search of papers published between 1966 and 2010 was carried out and 59 papers were considered for the present study; there were 19 cohort studies and 40 case reports. The majority of patients having groove pancreatitis were middle aged. Mean age was significantly higher in patients having groove carcinoma. The diagnosis of cystic dystrophy of the duodenal wall can now be assessed by multidetector computer tomography, magnetic resonance imaging and endoscopic ultrasonography. These latter two techniques may also add more information on the involvement of the remaining pancreatic gland not involved by the duodenal malformation and they may help in differentiating "groove pancreatitis" from "groove adenocarcinoma". In conclusion, chronic pancreatitis involving the entire pancreatic gland was present in half of the patients with cystic dystrophy of the duodenal wall and, in the majority of them, the pancreatitis had calcifications.

Pancreas-Preserving Approach to “Paraduodenal Pancreatitis” Treatment: Why, When, and How? Experience of Treatment of 62 Patients with Duodenal Dystrophy

“…Computed tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) appeared the most accurate methods for DD diagnostics in our study and elsewhere [9–13]. All the methods demonstrated equally high sensitivity and specificity.…”

Groove Pancreatitis: Spectrum of Imaging Findings and Radiology-Pathology Correlation

“…Several different terms have been coined for chronic inflammatory processes centered in the pancreaticoduodenal groove, including groove pancreatitis, cystic dystrophy of the heterotopic pancreas, periampullary duodenal wall cyst, pancreatic hamartoma of the duodenal wall, myoadenomatosis, and cystic dystrophy of the duodenal wall [5, 19]. This group of disorders, all of which are considered to be relatively similar from a histopathologic perspective, have clinically been grouped together and termed “paraduodenal pancreatitis.” Practically speaking, the different entities in this group do not substantially differ in terms of their clinical presentations and radiologic appearances and should all be considered as being within the spectrum of groove pancreatitis.…”

Groove Pancreatitis: A Description of Four Cases and Literature Review

“…Knowledge of the clinical and pathological features of groove pancreatitis is important because it allows a preoperative diagnosis that in most cases correctly differentiates it from pancreatic and periampullary neoplasms and may prevent unnecessary surgical resection [6] Etiology of GP is heterogeneous with a variety of factors playing a role in its development, including: anatomic disruption or functional obstruction of the minor papilla, disruption of the pancreatic juice flow, pancreatic heterotopia in the duodenum, pancreas divisum, chronic alcohol consumption and secondary modifications of local anatomy due to gastrectomy, gastroduodenal ulcer and biliary disease [7][8][9].…”