Groove Pancreatitis

Brooke R. Jeffrey, MD

Michael P. Federle, MD, FACR

Key Facts

Terminology

Chronic segmental pancreatitis in pancreaticoduodenal groove
- Pancreaticoduodenal groove is defined by head of pancreas (medially) and 2nd portion of duodenum (laterally)
- Distal CBD traverses posterior aspect of groove

Imaging

Hypodense nonenhancing mass in groove
Thickened duodenal wall with delayed enhancement
- Narrowed lumen ± cysts in wall
Smooth narrowing of terminal CBD and pancreatic duct

Top Differential Diagnoses

Pancreatic carcinoma
- Hypodense rounded mass in head; marked atrophy upstream

Pathology

Alcohol consumption leads to ↑ viscosity of pancreatic juice → Brunner gland hyperplasia → occlusion of minor papilla
Abnormal minor papilla (absent or rudimentary)
Tumors occluding minor papilla and Santorini duct
Ectopic pancreatic tissue in duodenal wall
Chronic inflammation of terminal CBD, gastric surgery, duodenal/gastric ulcer → fibrosis/scar tissue

Clinical Issues

Postprandial abdominal pain, vomiting
More common in middle-aged men with history of alcohol consumption

(Left) Axial CECT shows a markedly distended stomach and proximal duodenum

from a gastric outlet obstruction. Note inflammatory exudate in the groove between the 2nd duodenum and the pancreas

. (Right) More caudal CECT of the same patient shows that the lumen of the 2nd portion of duodenum is markedly narrowed

by inflammation, and there is a small cystic collection in the pancreatic groove

(Left) Axial CECT shows low-attenuation inflammatory exudate in the groove between the head of the pancreas and the 2nd duodenum

. Note the stent in the common duct

placed due to biliary obstruction from the adjacent inflammatory process. (Right) Axial volume-rendered CECT shows that the hypodense inflammation encases the gastroduodenal artery