The epidemiology of groove pancreatitis is similar to that of run-of-the-mill chronic pancreatitis.
The clinical presentation of groove pancreatitis is dominated by symptoms resulting from marked duodenal stenosis and impaired motility with patients presenting with nausea and vomiting. Occasionally jaundice is present, but often fluctuates, as biliary outflow obstruction is intermittent.
Amylase serum levels may be elevated.
The pathogenesis of groove pancreatitis remains controversial.
The histopathologic hallmark of groove pancreatitis is the presence of scar tissue with fibrosis in the pancreatico-duodenal 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.
Groove pancreatitis is usually classified into two forms, pure and segmental.
- pure form : affects exclusively the groove
- segmental form : extends to the pancreatic head despite a clear predominance in the groove
On CT-scan, the following findings are usually seen :
- cystic thickening of the duodenal wall with or without duodenal stenosis
- fibrous tissue within the pancreaticoduodenal groove (may show late enhancement after contrast administration)
- common bile ducts dilatation
Similar findings are seen on ultrasound. Fibrous tissue appear as a hypoechoic lesion within the pancreaticoduodenal groove.
The most characteristic finding on MRI is a sheetlike mass between the head of pancreas and the duodenum 4.
Signal characteristics include
- T1 : hypo-intense to pancreatic parenchyma
- T2 : hypo-, iso-, or slightly hyperintense
Associated finding include:
- inflammatory changes of the pancreas
- duodenal stenosis
- local cysts
- regular tapering of the pancreatic and common bile ducts
- widening of space between distal pancreatic and common bile ducts, and duodenal lumen at MRCP10
- Banana-shaped gallbladder10
It was first described by V Becker (German phyisician) in 1973 3.
The most relevant differential diagnosis of groove pancreatitis (particularly in its segmental form) is pancreatic adenocarcinoma of the head of the pancreas.
- 1. Blasbalg R, Baroni RH, Costa DN et-al. MRI features of groove pancreatitis. AJR Am J Roentgenol. 2007;189 (1): 73-80. doi:10.2214/AJR.06.1244 - Pubmed citation
- 2. Shanbhogue AK, Fasih N, Surabhi VR et-al. A clinical and radiologic review of uncommon types and causes of pancreatitis. Radiographics. 29 (4): 1003-26. doi:10.1148/rg.294085748 - Pubmed citation
- 3. Becker V. Bauchspeicheldruse (Inselapparat ausgenommen). In: Doerr W, ed. Spezielle pathologische Anatomie. Berlin, Germany: Springer, 1973
- 4. Irie H, Honda H, Kuroiwa T et-al. MRI of groove pancreatitis. J Comput Assist Tomogr. 22 (4): 651-5. J Comput Assist Tomogr (link) - Pubmed citation
- 5. Wronski M, Karkocha D, Slodkowski M et-al. Sonographic findings in groove pancreatitis. J Ultrasound Med. 2011;30 (1): 111-5. J Ultrasound Med (full text) - Pubmed citation
- 6. Itoh S, Yamakawa K, Shimamoto K et-al. CT findings in groove pancreatitis: correlation with histopathological findings. J Comput Assist Tomogr. 18 (6): 911-5. - Pubmed citation
- 7. Castell-monsalve FJ, Sousa-martin JM, Carranza-carranza A. Groove pancreatitis: MRI and pathologic findings. Abdom Imaging. 33 (3): 342-8. doi:10.1007/s00261-007-9245-x - Pubmed citation
- 8. Ito K, Koike S, Matsunaga N. MR imaging of pancreatic diseases. Eur J Radiol. 2001;38 (2): 78-93. Eur J Radiol (link) - Pubmed citation
- 9. Shanbhogue AK, Fasih N, Surabhi VR et-al. A clinical and radiologic review of uncommon types and causes of pancreatitis. Radiographics. 2009;29 (4): 1003-26. Radiographics (full text) - doi:10.1148/rg.294085748 - Pubmed citation
- 10. Blasbalg R, Baroni RH, Costa DN et-al. MRI features of groove pancreatitis. AJR Am J Roentgenol. 2007;189 (1): 73-80. doi:10.2214/AJR.06.1244 - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Groove type pancreatitis||✗|