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

Abstract

Background. The term “paraduodenal pancreatitis” (PP) was proposed as a synonym for duodenal dystrophy (DD) and groove pancreatitis, but it is still unclear what organ PP originates from and how to treat it properly. Objective. To assess the results of different types of treatment for PP. Method. Prospective analysis of 62 cases of PP (2004–2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded. Results. Preoperative diagnosis was correct in all the cases except one (1.9%). Patients presented with abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Ten patients were treated conservatively, 24 underwent pancreaticoduodenectomies (PD), pancreatico- and cystoenterostomies (8), Nakao procedures (5), duodenum-preserving pancreatic head resections (5), and 10 pancreas-preserving duodenal resections (PPDR) without mortality. Full pain control was achieved after PPRDs in 83%, after PDs in 85%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD. Conclusions. PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not “paraduodenal,” origin.

Paraduodenal Pancreatitis: Three Cases with Different Therapeutic Approaches

“…The technique usually performed is the Whipple procedure [4] , but some authors sustain that more conservative interventions, such as suprapapillary segmental duodenal resection, should be considered in cases of isolated duodenal dystrophy [13] . Apart of the procedure used, it is proved that surgery highly improves quality of life and contributes to pain cessation [2] .…”

The role of diffusion-weighted imaging in the diagnosis of thymic metastasis

“…This was following an observation by Adsay and Zamboni that all these entities shared common clinicopathological features of a fibroinflammatory process centered at the descending duodenum (primarily in the minor papilla region) in young chronic alcoholic men, often associated with varying degrees of involvement of the pancreaticoduodenal groove and/ or the adjoining pancreas [4,5]. Since then, the term paraduodenal pancreatitis has been popular in the medical literature [5][6][7][8][9][10]. Of course, what matters is that the entity should be correctly diagnosed and differentiated from pancreatic adenocarcinoma and not what it is called.…”

“…Nevertheless, it is vital to stay abreast with the newer terminologies. This becomes especially relevant while collating up-to-date medical information on search tools such as PubMed [5][6][7][8][9][10].…”

Diagnosis and treatment of duodenal dystrophy in patients with chronic pancreatitis

“…Лечебная тактика при ДД также далека от раз-решения и варьирует от консервативной терапии и эндоскопического стентирования до панкреатодуо-денальной резекции [5,14,21].…”