Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2945-2953
Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2945
Duodenojejunostomy treatment of groove pancreatitis-induced stenosis and obstruction of the horizontal duodenum: A case report
Yu Zhang, Heng-Hui Cheng, Wen-Juan Fan
Yu Zhang, Wen-Juan Fan, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Heng-Hui Cheng, Institution of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Zhang Y reviewed the literature and contributed to manuscript drafting and imaging data interpretation; Cheng HH evaluated all of the patient’s pathological information and provided pathological pictures; Fan WJ was responsible for revising the manuscript for important intellectual content; All authors provided approval of the final version for submission and publication.
Supported by National Natural Science Foundation of China, No. 82100568.
Informed consent statement: Informed written consent was obtained from family members of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Juan Fan, MD, Attending Doctor, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan 430030, Hubei Province, China. juanwenfan1989@163.com
Received: September 11, 2023
Peer-review started: September 11, 2023
First decision: November 9, 2023
Revised: November 10, 2023
Accepted: December 2, 2023
Article in press: December 2, 2023
Published online: December 27, 2023
Processing time: 107 Days and 3.7 Hours
Abstract
BACKGROUND

Groove pancreatitis (GP) is a rare condition affecting the pancreatic groove region within the dorsal-cranial part of the pancreatic head, duodenum, and common bile duct. As a rare form of chronic pancreatitis, GP poses a diagnostic and therapeutic challenge for clinicians. GP is frequently misdiagnosed or not considered; thus, the diagnosis is often delayed by weeks or months. The treatment of GP is complicated and often requires surgical intervention, especially pancreatoduodenectomy.

CASE SUMMARY

A 66-year-old man with a history of long-term drinking was admitted to the gastroenterology department of our hospital, complaining of vomiting and acid reflux. Upper gastrointestinal endoscopy showed luminal stenosis in the descending part of the duodenum. Abdominal computed tomography showed slight exudation in the descending and horizontal parts of the duodenum with broadening of the groove region, indicating local pancreatitis. The symptoms of intestinal obstruction were not relieved with conservative therapy, and insertion of an enteral feeding tube was not successful. Exploratory laparoscopy was performed and revealed a hard mass with scarring in the horizontal part of the duodenum and stenosis. Intraoperative frozen section analysis showed no evidence of malignancy, and side-to-side duodenojejunostomy was performed. Routine pathologic examination showed massive proliferation of fibrous tissue, hyaline change, and the proliferation of spindle cells. Based on the radiologic and pathologic characteristics, a diagnosis of GP was made. The patient presented with anastomotic obstruction postoperatively and took a long time to recover, requiring supportive therapy.

CONCLUSION

GP often involves the descending and horizontal parts of the duodenum and causes duodenal stenosis, impaired duodenal motility, and gastric emptying due to fibrosis.

Keywords: Groove pancreatitis, Duodenal stenosis, Duodenal obstruction, Duodenojejunostomy, Case report

Core Tip: Groove pancreatitis (GP) is an uncommon form of chronic pancreatitis affecting the pancreatic groove region. In this case study, upper gastrointestinal endoscopy showed duodenal stenosis and abdominal computed tomography showed probable local pancreatitis. The symptoms of intestinal obstruction were not relieved with conservative therapy. Exploratory laparoscopy revealed a hard mass with scarring in the horizontal part of the duodenum and stenosis. Duodenojejunostomy was performed and routine pathologic examination of the mass biopsy showed extensive proliferation of fibrous tissue, indicating GP. Despite surgical therapy, the patient presented with anastomotic obstruction postoperatively and took a long time to recover.