Groove pancreatitis is a segmental chronic pancreatitis that affects the anatomical area between the pancreatic head, the duodenum, and the common bile duct, referred to as the groove area. Most patients with groove pancreatitis are males aged 40–50 years with a history of alcohol abuse. In about 20% of patients undergoing pancreaticoduodenectomy to treat chronic pancreatitis, groove pancreatitis is detected. The clinical symptoms are weight loss, upper abdominal pain, postprandial vomiting, and nausea due to duodenal stenosis. The pathogenesis of groove pancreatitis is thought to be anatomical or functional obstruction of the minor papilla. The viscosity of pancreatic juice increases due to excessive alcohol consumption and/or smoking, leading to calcification of the pancreatic duct. According to these conditions, pancreatitis in the groove area might arise due to impaired pancreatic juice outflow. The descending part of the duodenum is usually stenotic. Severe fibrosis and scarring are evident in the groove area. Characteristic pathological findings are cystic lesions in the duodenal wall, Brunner gland hyperplasia, dilation of Santorini’s duct and protein plaques in the pancreatic duct. A differential diagnosis of groove pancreatitis from peripancreatic cancer is clinically important. Cystic lesions in the duodenal wall and smooth stenosis of the bile duct are important findings of groove pancreatitis revealed by endoscopic ultrasonography, computed tomography and magnetic resonance imaging. Biopsy through the duodenum is also useful for diagnosis. Conservative treatment options include endoscopic stenting of the minor papilla, but long-term outcomes remain unclear. Pancreatoduodenectomy is a rational treatment for symptomatic groove pancreatitis.

Keywords:
Alcohol abuse, Common bile duct, Groove pancreatitis, Intraduodenal cyst, Pancreatoduodenectomy
1.
Becker V: Bauchspeicheldrüse; in Doerr W, Seifert G, Uhlinger E (eds): Spezielle pathologische Anatomie. Berlin, Springer, 1973, vol 4.
2.
Stolte M, Weiss W, Volkholz H, Rösch W: A special form of segmental pancreatitis: ‘groove pancreatitis’. Hepatogastroenterology 1982;29:198–208.
3.
Adsay NV, Zamboni G: Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying ‘cystic dystrophy of heterotopic pancreas’, ‘para-duodenal cyst’, and ‘groove pancreatitis’. Semin Diagn Pathol 2004;21:247–254.
4.
Potet F, Duclert N: Cystic dystrophy on aberrant pancreas of the duodenal wall. Arch Fr Mal App Dig 1970;59:223–238.
5.
Solcia E, Capella C, Klöppel G: Tumors of the Pancreas. AFIP Atlas of Tumor Pathology Third Series, Fascicle 20. Washington, Armed Forces Institute of Pathology, 1997.
6.
McFaul CD, Vitone LJ, Campbell F, Azadeh B, Hughes ML, Garvey CJ, Ghaneh P, Neoptolemos JP: Pancreatic hamartoma. Pancreatology 2004;4:533–538.
7.
Bill K, Belber JP, Carson JW: Adenomyoma (pancreatic heterotopia) of the duodenum producing common bile duct obstruction. Gastrointest Endosc 1982;28:182–184.
8.
Becker V, Mischke U: Groove pancreatitis. Int J Pancreatol 1991;10:173–182.
9.
Ohta T, Nagakawa T, Kobayashi H, Kayahara M, Ueno K, Konishi I, Miyazaki I: Histomorphological study on the minor duodenal papilla. Gastroenterol Jpn 1991;26:356–362.
10.
Zamboni G, Capelli P, Scarpa A, Bogina G, Pesci A, Brunello E, Klöppel G: Nonneoplastic mimickers of pancreatic neoplasms. Arch Pathol Lab Med 2009;133:439–453.
11.
Shudo R, Obara T, Tanno S, Fujii T, Nishino N, Sagawa M, Ura H, Kohgo Y: Segmental groove pancreatitis accompanied by protein plugs in Santorini’s duct. J Gastroenterol 1998;33:289–294.
12.
Balakrishnan V, Chatni S, Radhakrishnan L, Narayanan VA, Nair P: Groove pancreatitis: a case report and review of literature. JOP 2007;8:592–597.
13.
Yamaguchi K, Tanaka M: Groove pancreatitis masquerading as pancreatic carcinoma. Am J Surg 1992;163:312–318.
14.
Shudo R, Yazaki Y, Sakurai S, Uenishi H, Yamada H, Sugawara K, Okamura M, Yamaguchi K, Terayama H, Yamamoto Y: Groove pancreatitis: report of a case and review of the clinical and radiologic features of groove pancreatitis reported in Japan. Intern Med 2002;41:537–542.
15.
Mohl W, Hero-Gross R, Feifel G, Kramann B, Püschel W, Menges M, Zeitz M: Groove pancreatitis: an important differential diagnosis to malignant stenosis of the duodenum. Dig Dis Sci 2001;46:1034–1038.
16.
Itoh S, Yamakawa K, Shimamoto K, Endo T, Ishigaki T: CT findings in groove pancreatitis: correlation with histopathological findings. J Comput Assist Tomogr 1994;18:911–915.
17.
Irie H, Honda H, Kuroiwa T, Hanada K, Yoshimitsu K, Tajima T, Jimi M, Yamaguchi K, Masuda K: MRI of groove pancreatitis. J Comput Assist Tomogr 1998;22:651–655.
18.
Rahman SH, Verbeke CS, Gomez D, McMahon MJ, Menon KV: Pancreatico-duodenectomy for complicated groove pancreatitis. HPB (Oxford) 2007;9:229–234.
19.
Blasbalg R, Baroni RH, Costa DN, Machado MC: MRI features of groove pancreatitis. AJR Am J Roentgenol 2007;189:73–80.
20.
Levenick JM, Gordon SR, Sutton JE, Suriawinata A, Gardner TB: A comprehensive, case-based review of groove pancreatitis. Pancreas 2009;38:e169–e175.
21.
Gabata T, Kadoya M, Terayama N, Sanada J, Kobayashi S, Matsui O: Groove pancreatic carcinomas: radiological and pathological findings. Eur Radiol 2003;13:1679–1684.
22.
Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M, Frulloni L, Crippa S, Zamboni G, Pederzoli P: ‘Paraduodenal’ pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg 2009, E-pub ahead of print.
23.
Isayama H, Kawabe T, Komatsu Y, Sasahira N, Toda N, Tada M, Nakai Y, Yamamoto N, Hirano K, Tsujino T, Yoshida H, Omata M: Successful treatment for groove pancreatitis by endoscopic drainage via the minor papilla. Gastrointest Endosc 2005;61:175–178.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.