Groove Pancreatitis: A Case Report and Review of a Hidden Type of Chronic Pancreatitis

Abstract

Groove pancreatitis is a chronic type of segmental or focal pancreatitis seen to affect the groove, which is the region between the head of the pancreas, the duodenum, and the common bile duct. Despite its incidence remaining unknown, it accounts for 2.7% to 24.5% of pancreaticoduodenectomies performed for chronic pancreatitis. A diverse etiology has been implicated but the exact cause is yet to be identified. As it closely mimics pancreatic malignancy and remains mostly undiagnosed preoperatively, many patients often end up undergoing a pancreaticoduodenectomy. Awareness of this entity and early diagnosis will help us address this issue with more conservative measures than by resorting to a morbid procedure such as a pancreaticoduodenectomy.We report a case of a 50-year-old male, a chronic alcoholic, with a two-year history of upper abdominal pain, postprandial vomiting, and weight loss. An abdominal contrast-enhanced computed tomography (CECT) scan was suggestive of either a pancreatic malignancy or a possibility of groove pancreatitis. However, postoperative histopathological examination confirmed the lesser known groove pancreatitis. Here, we review the clinical, radiological, and pathological characteristics of groove pancreatitis, as its diagnosis and management still pose a challenge.

Surgical Management of Groove Pancreatitis: A Case Report

“…Jaundice may also occur in some cases [12], as well as diabetes mellitus [13]. Laboratory results reveal a concomitant twofold or threefold increase of amylase and lipase concentration in the serum at the proximal of 80% of the patients, while tumor markers, such as CA19-9 and carcinoembryonic antigen-CEA, are usually within the normal limits [14][15][16].…”

“…T2-weighted images may also reveal cystic lesions of the duodenal wall and the groove [17,21,22]. Magnetic resonance cholangiopancreatography (MRCP) can detect abnormalities of the main pancreatic duct, the common bile duct, and the ampulla of Vater [6,15,18]. Compared to CT, MRI can visualize the involvement of the pancreas better since the head of the pancreas shows decreased T1 signal intensity due to parenchymal atrophy and fibrosis [23].…”

“…Finally, Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) can reveal smooth tubular stenosis of the common various bile duct with the main pancreatic duct remaining intact. In addition, EUS represents one of the most sensitive methods for detecting pancreaticobiliary lesions and might detect stenosis of the second part of the duodenum, cysts or pseudocysts of the duodenal wall, and masses located in the groove area or the head of the pancreas, while at the same time providing the possibility of taking biopsies with terms of EUS-Fine Needle Aspiration (FNA) [15,16].…”

“…As regards the conservative treatment, it aims to substitute the pancreatic function with a pancreatic enzyme supplement and relieve the patient's pain with sufficient analgesia [25]. Other measures that help pancreatic function recovery are avoidance of smoking and alcohol consumption, parenteral nutrition, and proton pump inhibitors [15,17]. Endoscopic drainage or stenting of the pancreatic duct poses an intervention less invasive than surgery, and it is preferred in patients not suitable for surgery due to their general condition and several comorbidities [26].…”