Groove pancreatitis

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[edit] Discussion of Groove pancreatitis

  • Groove pancreatitis is an uncommon type of focal chronic pancreatitis affecting the groove between the head of the pancreas, the duodenum, and the common bile duct.
  • The pancreatic parenchyma is spared or slightly compromised.
  • The clinical setting is similar to the usual form of chronic pancreatitis, but recurrent vomiting, attributable to marked duodenal stenosis and impaired motility, tends to be more pronounced in groove pancreatitis.
  • Jaundice is not usual and, if present, often fluctuates, in contrast to the continuously progressive jaundice found in patients with pancreatic carcinoma.
  • Amylase serum levels may be elevated.
  • The pathogenesis of groove pancreatitis remains controversial.

  • Groove pancreatitis is usually classified into pure and segmental forms.
    • The pure form affects exclusively the groove.
    • The segmental form extends to the pancreatic head despite a clear predominance in the groove.

  • The histopathologic hallmark of groove pancreatitis is the presence of scar tissue with fibrosis in the pancreaticoduodenal groove or in the groove and the superior portion of the pancreatic head (in the pure and segmental forms of the disease, respectively).
  • The duodenum is always involved by a chronic inflammatory process, with scar tissue in the wall leading to fibrosis and various levels of stenosis.
  • The most relevant differential diagnosis of groove pancreatitis (particularly in its segmental form) is pancreatic adenocarcinoma of the head of the pancreas.

[edit] Imaging Findings for Groove pancreatitis

[edit] MRI

  • The most characteristic finding on MRI is a sheetlike mass between the head of pancreas and the C-loop of duodenum.
  • The mass is hypointense to pancreatic parenchyma on T1-weighted images and can be hypo-, iso-, or slightly hyperintense on T2-weighted images.
  • Associated finding
    • Inflammatory changes of the pancreas
    • Duodenal stenosis
    • Cysts
    • Regular tapering of the pancreatic and common bile ducts

[edit] Images

Patient #1

[edit] See Also

[edit] External Links

[edit] References for Groove pancreatitis

  • Blasbalg, Roberto, Baroni, Ronaldo Hueb, Costa, Daniel Nobrega, Machado, Marcel Cerqueira Cesar. MRI Features of Groove Pancreatitis. Am. J. Roentgenol. 2007 189: 73-80[[Category:GI inflammation]