Groove pancreatitis; two cases with different clinical course

Öz

Groove pancreatitis is a rare chronic segmental pancreatitis affecting the groove area of the pancreas (anatomical region between the head of the pancreas, duodenum, and common bile duct). It's often seen in middle-aged males with histories of heavy alcohol and nicotine use. In this report, we present two cases of groove pancreatitis that were diagnosed and followed in our clinic, each with a different clinical course. In the first case, a patient presented with episodic pancreatitis, abdominal pain, nausea and vomiting. A diagnosis of stenosis in the transition from the first to second segment of the duodenum was made using upper gastrointestinal endoscopy. A significant improvement in symptoms occurred after the patient underwent a Whipple procedure (pancreaticoduodenectomy). In the second case, a patient complained of abdominal pain, weight loss and jaundice. Radiologic imaging showed dilatation of the common bile duct. A biliary stent was placed in the common bile duct and the patient was followed for three months; during this time, the patient refrained from alcohol use, bilirubin levels returned to normal and the patient remained asymptomatic. The biliary stent was then removed and no further clinical or laboratory recurrence was observed after the three-month period. These cases demonstrate that groove pancreatitis treatment varies according to a patient's clinical indications and the location of involvement. Groove pancreatitis, a rare form of chronic pancreatitis, should be considered in male patients between the ages of 30 to 50 years old, who present with a history of heavy alcohol and cigarette use.

Anahtar Kelimeler

• Pancreatitis, groove, treatment

Groove pankreatit; farklı klinik seyir gösteren iki olgu

Öz

Groove pankreatit, groove alan olarak adlandırılan pankreas başı, duodenum ve koledok arasındaki anatomik bölgeyi etkileyen kronik segmental pankreatittir. Alkol ve sigara kullanım öyküsü olan genç erkek hastalarda sıklıkla görülmektedir. Bu yazıda kliniğimizde tanı koyarak izlediğimiz farklı klinik tablo ile seyreden iki groove pankreatitli olgu sunmaktayız. Birinci olgu; öyküsünde pankratit atakları tanımlayan, karın ağrısı, bulantı, kusma şikayetleri olan ve üst gastrointestinal sistem endokopisinde duodenum 2. segmente geçişte darlık saptanan hastamızdı. Bu olguda pankreatiko-duodenektomi sonrası semptomlarda belirgin iyileşme oldu. İkinci olgumuzda ise karın ağrısı, kilo kaybı ve ikter şikayetleri mevcuttu. Radyolojik görüntülemede koledokta dilatasyon saptanması üzerine koledoğa biliyer stent konularak hasta alkolsüz olarak 3 ay izlendi. 3 aylık takip sonucunda hem semptomatik iyileşme, hem de bilirübin seviyelerinde normalizasyon elde edildi. Daha sonrasında biliyer stent çıkarılarak izleme alındığında 3 aylık periyotta klinik ve laboratuvar olarak nüks saptanmadı. Bu iki olguda olduğu gibi groove pankreatit tedavisi hastanın klinik ve tutulum yerinin farklılığına göre değişmektedir. Alkol ve sigara kullanım öyküsü olan 40-50 yaş erkek hastalarda kronik pankreatitin bir formu olan groove pankreatit akılda tutulmalıdır.

Anahtar Kelimeler

• Pankreatit, groove, tedavi

Kaynakça

1. Becker V, Bauchspeichel D. Spezielle Pathologische Anatomic Bd. VI. In: Doerr W, Seifert G, Uhlinger E, Eds. Springer, Berlin-Heidel- berg-New York, 1973.
2. Stolte M, Weiss W, Volkholz H, Rosch W. A special form of seg- mental pancreatitis: groove pancreatitis. Hepatogastroenterology 1982;29:198-208.
3. Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinicopath- ologically distinct entity unifying ‘cystic dystrophy of heterotopic pancreas’, ‘para-duodenal wall cyst’, and ‘groove pancreatitis’. Se- min Diagn Pathol 2004;21:247-54.
4. Becker V, Mischke U. Groove pancreatitis. Int J Pancreatol 1991;10:173-82.
5. Yamaguchi K, Tanaka M. Groove pancreatitis masquerading as pancreatic carcinoma. Am J Surg 1992;163:312-6.
6. Ohta T, Nagakawa T, Kobayashi H, et al. Histomorphological study on the minor duodenal papilla. Gastroenterol Jpn 1991;26:356-62.
7. Zamboni G, Capelli P, Scarpa A, et al. Nonneoplastic mimickers of pancreatic neoplasms. Arch Pathol Lab Med 2009;133:439-53.
8. Balakrishnan V, Chatni S, RadhakrishnanL et al. Groove pancreati- tis: a case report and review of the literature. JOP 2007;8:592-7.

9. Shudo R, Obara T, Tanno S, et al. Segmental groove pancreatitis accompanied by protein plugs in Santorini’s duct. J Gastroenterol 1998;33:289-94.
10. Yamaguchi K, Tanaka M. Groove pancreatitis masquerading as pancreatic carcinoma. Am J Surg 1992;163:317-8.