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Groove pancreatitis

Dr Jan Frank Gerstenmaier and Radswiki et al.

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.

Epidemiology

The epidemiology of groove pancreatitis is similar to that of run-of-the-mill chronic pancreatitis.

Clinical presentation

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.

Pathology

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.

Radiographic features

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

CT-scan

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

Ultrasound

Similar findings are seen on ultrasound. Fibrous tissue appear as a hypoechoic lesion within the pancreaticoduodenal groove.

MRI

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

Etymology

It was first described by V Becker (German phyisician) in 1973 ³.

Differential diagnosis

The most relevant differential diagnosis of groove pancreatitis (particularly in its segmental form) is pancreatic adenocarcinoma of the head of the pancreas.

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