Pancreatoduodenectomy and surgical treatment of groove pancreatitis.

BACKGROUND

Groove pancreatitis is an unusual form of chronic pancreatitis that can be mistaken for a pancreatic head neoplasm.

BACKGROUND

Once the diagnosis is confirmed, clinical management follows the standard recommendations for chronic pancreatitis.

BACKGROUND

Surgery is indicated when clinical treatment fails or when there is diagnostic uncertainty regarding pancreatic neoplasia.

BACKGROUND

Pancreatoduodenectomy is an effective treatment option when performed in high-volume referral centers.

BACKGROUND

Groove pancreatitis (GP) is a rare, segmental form of chronic pancreatitis that primarily affects individuals between 40 and 50 years of age. It has been referred to by various other names, such as paraduodenal pancreatitis, cystic dystrophy of heterotopic pancreas, duodenal dystrophy, duodenal pancreatic hamartoma, paraduodenal wall cyst, and myoadenomatosis. This distinct and sporadic form of pancreatitis (GP) can be classified, depending on the affected segment, into a segmental form - affecting the entire pancreatic head - and a pure form limited to the pancreaticoduodenal groove, with preservation of the remaining pancreatic parenchyma. Its true incidence, as well as its pathophysiological mechanisms, remains unknown.

BACKGROUND

Groove pancreatitis is a rare, segmental form of chronic pancreatitis that, in some cases, may be mistaken for pancreatic head neoplasia, with imaging modalities including endoscopic ultrasound currently playing a key role in its diagnosis. A review of the medical papers indicates that initial treatment should be multidisciplinary, similar to the management of classic chronic pancreatitis. When there is little or no response to conservative and/or endoscopic treatment, surgical intervention is indicated, and pancreatoduodenectomy is a good option, provided it is performed in centers with extensive experience in pancreatobiliary surgery.

BACKGROUND

Groove pancreatitis (GP) is a rare and segmental form of chronic pancreatitis that affects the pancreaticoduodenal sulcus. Its pathophysiology is still not well known, and several etiological factors have been attributed, with chronic alcohol consumption being the most common association. Its treatment still generates controversy. The initial clinical approach followed by endoscopic therapies prevails. Surgery is indicated when these treatment options fail.

AIMS

The aim of this study was to analyze the clinical, imaging, and surgical treatment data of a series of patients diagnosed with GP.

METHODS

The clinical, radiological, surgical, and postoperative follow-up data were analyzed, in addition to the histopathological results of chronic pancreatitis, in patients undergoing pancreaticoduodenectomy.

RESULTS

A total of eight patients were included, of whom six were male, and their mean age was 45 years. The main symptom presented was long-standing abdominal pain with the use of analgesics and weight loss; all patients were chronic alcoholics. Imaging methods defined the diagnosis of GP in the preoperative period in five patients. In three patients, the preoperative diagnosis was neoplasia of the head of the pancreas. All patients underwent pancreaticoduodenectomy and one patient developed pancreatic fistula. There was a regression of pain in all patients.

CONCLUSIONS

For patients with GP who do not respond to the clinical approach, or in the face of diagnostic doubt, pancreaticoduodenectomy constitutes a good therapeutic option.