A unique case of focal pancreatitis termed Groove pancreatitis

Groove pancreatitis (GP) is an unusual form of chronic segmental pancreatitis that affects the “pancreatic groove” between the pancreatic head, the duodenum, and the common bile duct, also known as the groove area. Most physicians are still unfamiliar with an entity. It is a rare pancreatic condition.

A recent case report published in the Journal of Clinical Imaging Science (Scientific Journal) has shown that it is challenging to make the diagnosis of Groove pancreatitis or GP on imaging. The report by researchers from NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, also highlighted the importance of having a high index of its suspicion when a pancreatic head abnormality is detected to avoid unnecessary surgical intervention which can be avoided in cases of GP.

It was the case of a 21 years old male patient, who came to the emergency department with complaints of sharp upper abdominal pain irradiating to the back and a few episodes of vomiting. Abdominal ultrasonography (US) was performed.

A hypoechoic lesion was noted in the space bounded by the pancreatic head and duodenum wall, which showed no vascularity on color Doppler. The division of 2nd part of the duodenum appeared to be thickened. Cystic changes were noted in the para duodenal space, which was compressing over the lumen of the duodenum . The pancreatic body and tail were unremarkable. The main pancreatic duct and CBD were not dilated. There was no obstruction or encasement of peripancreatic vessels throughout their course.

On preliminary plain CT, a hypodense soft-tissue density mass sheet-like appearance was noted in the pancreaticoduodenal groove, associated with minimal surrounding inflammatory stranding of the fat and thickening of the duodenal wall.

An ill-defined peripherally enhancing cyst was noted in the periphery of the duodenum, which appeared to be compressing over the lumen of the duodenum, causing focal stenosis. After contemplating and combining the clinical and imaging findings, the case was interpreted as a case of GP.

Reference: Joshi SS, Dhok A, Mitra K, Onkar P. Groove pancreatitis: A unique case of focal pancreatitis. J Clin Imaging Sci 2022;12:54.