Friday, March 5, 2010

Groove Pancreatitis

Groove pancreatitis is a form of chronic segmental pancreatitis affecting the pancreaticoduodenal groove. A number of conditions have been associated with groove pancreatitis, including peptic ulcers, gastric resection, true duodenal-wall cysts, and pancreatic heterotopia in the duodenal wall.

Groove pancreatitis has been divided into pure and segmental forms. The pure form affects only the groove, sparing the pancreas, while the segmental form involves the head of the pancreas.

CT may reveal soft-tissue attenuation material between the pancreatic head and the adjacent duodenum with or without small cystic lesions in the thickened duodenal wall (cystic dystrophy of the duodenal wall, see below). MRI may reveal a sheetlike mass corresponding to fibrous scar in the pancreatoduodenal groove that is hypointense relative to the pancreatic parenchyma on T1-weighted images and isointense or slightly hyperintense on T2-weighted images.

Cystic dystrophy of the duodenal wall is most likely related to groove pancreatitis and may be part of the spectrum of paraduodenal pancreatitis, which includes groove pancreatitis, cystic dystrophy of the duodenal wall, and paraduodenal wall cysts. These all occur in and around the minor papilla and have several features in common such as dilated ducts and cysts in the duodenal wall, Brunner gland hyperplasia, and hamartomatous pancreatic tissue in the groove.


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