A Case of Groove Pancreatitis Treated by Pancreatoduodenostomy with Initial Suspicion of Cancer

Hiroko Aruga, Hide Kasai, Hideo Koike, Tuneo Maeda

Department of Surgery, Aizawa Hospital

A 48-year-old man was admitted to our hospital with complaints of abdominal pain and vomiting. Endoscopic findings included marked stenosis and an edematous and reddish mucosa in the second portion of the duodenum. Ultrasonography revealed a mass measuring about 30 mm in diameter at the haed of the pancreas. Pancreatic carcinoma with duodenum involvement was suspected, but an abdominal CT scan did not show a mass at the pancreatic head and ERCP showed no abnormality of the main pancreatic duct. The patient improved conservative treatment but he was readmitted for vomiting. There was no progression of the size of the mass. Angiography showed a central avascular area and a slight increase in vascularity in the venous phase at the same site. MRI revealed a mixed solid and cystic tumor with unclear margins and hypovascularity. We suspected groove pancreatitis rather than pancreatic cancer, and performed a pancreatoduodenostomy. Histological examination showed marked fibrosis between the duodenal wall and the head of the pancreas. Segmental groove pancreatitis was diagnosed. The postoperative course was uneventful. We found reports of only 25 similar cases in Japan.

Key words
groove pancreatitis, obstruction of the Santorini's duct

Reprint requests
Hiroko Aruga Department of Surgery, Aizawa Hospital
2-5-1 Honjou, Matsumoto, 390-8510 JAPAN

Accepted
July 22, 1998

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