Pancreas-preserving Approach to "paraduodenal Pancreatitis" Treatment: Why, When, and How? Experience of Treatment of 62 Patients with Duodenal Dystrophy

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2014 Jul 5

PMID 24995273

Citations 14

Authors

V I Egorov

A N Vankovich

R V Petrov

N S Starostina

A Ts Butkevich

A V Sazhin

E A Stepanova

Affiliations

Soon will be listed here.

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.

Citing Articles

Paraduodenal pancreatitis as diagnostic challenge: clinical and morphological features of patients with pancreatic pathology involving the pancreatic groove.

Vitali F, Heinrich M, Strobel D, Zundler S, Aghdassi A, Uder M Ann Gastroenterol. 2024; 37(6):742-749.

PMID: 39568705 PMC: 11574150. DOI: 10.20524/aog.2024.0914.

Diagnostic value of endoscopic ultrasound in groove pancreatitis.

She Y, Ge N Ann Med. 2023; 55(2):2295991.

PMID: 38134890 PMC: 10763902. DOI: 10.1080/07853890.2023.2295991.

Systematic review on groove pancreatitis: management of a rare disease.

Ukegjini K, Steffen T, Tarantino I, Jonas J, Rossler F, Petrowsky H BJS Open. 2023; 7(5).

PMID: 37749756 PMC: 10519812. DOI: 10.1093/bjsopen/zrad094.

Imaging of paraduodenal pancreatitis: A systematic review.

Bonatti M, de Pretis N, Zamboni G, Brillo A, Crino S, Valletta R World J Radiol. 2023; 15(2):42-55.

PMID: 36874260 PMC: 9979191. DOI: 10.4329/wjr.v15.i2.42.

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

Teo J, Suthananthan A, Pereira R, Bettington M, Slater K ANZ J Surg. 2022; 92(9):2167-2173.

PMID: 35916436 PMC: 9543432. DOI: 10.1111/ans.17939.

References

Rebours V, Levy P, Vullierme M, Couvelard A, OToole D, Aubert A . Clinical and morphological features of duodenal cystic dystrophy in heterotopic pancreas. Am J Gastroenterol. 2007; 102(4):871-9. DOI: 10.1111/j.1572-0241.2007.01091.x. View

Leger L, LEMAIGRE G, LENRIOT J . [Cysts on heterotopic pancreas of the duodenal wall]. Nouv Presse Med. 1974; 3(36):2309-14. View

Jovanovic I, Alempijevic T, Lukic S, Knezevic S, Popovic D, Dugalic V . Cystic dystrophy in heterotopic pancreas of the duodenal wall. Dig Surg. 2008; 25(4):262-8. DOI: 10.1159/000148133. View

Bill K, BELBER J, Carson J . Adenomyoma (pancreatic heterotopia) of the duodenum producing common bile duct obstruction. Gastrointest Endosc. 1982; 28(3):182-4. DOI: 10.1016/s0016-5107(82)73049-4. View

Frey C, Mayer K . Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (frey procedure) and duodenum-preserving resection of the pancreatic head (beger procedure). World J Surg. 2003; 27(11):1217-30. DOI: 10.1007/s00268-003-7241-z. View

Scapa E, Broide E, Halevy A, Eshchar J . [Groove pancreatitis and adenocarcinoma of the pancreatic head]. Harefuah. 1994; 127(5-6):161-2, 215. View

Adsay N, Zamboni G . Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying "cystic dystrophy of heterotopic pancreas", "para-duodenal wall cyst", and "groove pancreatitis". Semin Diagn Pathol. 2005; 21(4):247-54. DOI: 10.1053/j.semdp.2005.07.005. View

Graziani R, Tapparelli M, Malago R, Girardi V, Frulloni L, Cavallini G . The various imaging aspects of chronic pancreatitis. JOP. 2005; 6(1 Suppl):73-88. View

Jouannaud V, Coutarel P, Tossou H, Butel J, Vitte R, Skinazi F . Cystic dystrophy of the duodenal wall associated with chronic alcoholic pancreatitis. Clinical features, diagnostic procedures and therapeutic management in a retrospective multicenter series of 23 patients. Gastroenterol Clin Biol. 2006; 30(4):580-6. DOI: 10.1016/s0399-8320(06)73231-6. View

10.

Hagai H . Configurational anatomy of the pancreas: its surgical relevance from ontogenetic and comparative-anatomical viewpoints. J Hepatobiliary Pancreat Surg. 2003; 10(1):48-56. View

11.

Procacci C, Graziani R, Zamboni G, Cavallini G, Pederzoli P, Guarise A . Cystic dystrophy of the duodenal wall: radiologic findings. Radiology. 1997; 205(3):741-7. DOI: 10.1148/radiology.205.3.9393530. View

12.

Pezzilli R, Santini D, Calculli L, Casadei R, Morselli-Labate A, Imbrogno A . Cystic dystrophy of the duodenal wall is not always associated with chronic pancreatitis. World J Gastroenterol. 2011; 17(39):4349-64. PMC: 3218148. DOI: 10.3748/wjg.v17.i39.4349. View

13.

Egorov V, Butkevich A, Sazhin A, Yashina N, Bogdanov S . Pancreas-preserving duodenal resections with bile and pancreatic duct replantation for duodenal dystrophy. Two case reports. JOP. 2010; 11(5):446-52. View

14.

Suda K, Takase M, Shiono S, Yamasaki S, Nobukawa B, Kasamaki S . Duodenal wall cysts may be derived from a ductal component of ectopic pancreatic tissue. Histopathology. 2002; 41(4):351-6. DOI: 10.1046/j.1365-2559.2002.01453.x. View

15.

Flejou J, POTET F, Molas G, Bernades P, Amouyal P, Fekete F . Cystic dystrophy of the gastric and duodenal wall developing in heterotopic pancreas: an unrecognised entity. Gut. 1993; 34(3):343-7. PMC: 1374138. DOI: 10.1136/gut.34.3.343. View

16.

Colardelle P, Chochon M, Larvol L, Palazzo L, Flejou J, Andrieu J . [Cystic dystrophy in an antro-duodenal heterotopic antroduodenal pancreas]. Gastroenterol Clin Biol. 1994; 18(3):277-80. View

17.

Seitz K, RETTENMAIER G, Stolte M . [Groove pancreatitis--its pathological anatomy and sonographic findings]. Ultraschall Med. 1985; 6(3):131-3. DOI: 10.1055/s-2007-1006041. View

18.

Izbicki J, Knoefel W, Muller-Hocker J, Mandelkow H . Pancreatic hamartoma: a benign tumor of the pancreas. Am J Gastroenterol. 1994; 89(8):1261-2. View

19.

Fujita N, Shirai Y, Tsukada K, Kurosaki I, Iiai T, Hatakeyama K . Groove pancreatitis with recurrent duodenal obstruction. Report of a case successfully treated with pylorus-preserving pancreaticoduodenectomy. Int J Pancreatol. 1997; 21(2):185-8. View

20.

Glaser M, Roskar Z, Skalicky M, Krajnc I . Cystic dystrophy of the duodenal wall in a heterotopic pancreas. Wien Klin Wochenschr. 2003; 114(23-24):1013-6. View