Hépato-Gastro & Oncologie Digestive


Paraduodenal pancreatitis Volume 26, issue 3, Mars 2019


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1 CHU de Bordeaux, Hôpital Haut-Lévêque, Service de chirurgie digestive, avenue Magellan, 33604 Pessac Cedex
2 CHU Rangueil-Larrey, Service de gastroentérologie et pancréatologie, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9
* Correspondance

The entity “paraduodenal pancreatitis” currently includes former terms such as “cystic dystrophy of the duodenal wall on ectopic pancreas” or “groove pancreatitis”. The lesions most often occur within the duodenum, in the vicinity of the minor papilla, combining inflammation, fibrosis and cystic dilation of ductal and acinar structures, all of which are responsible for duodenal stenosis. An extension of inflammatory phenomena to the duodenal groove and the head of the pancreas (including pseudocyst, necrosis, ductal dilation) is often seen. From a pathophysiological point of view, the role of alcohol is crucial, acting on the ectopic pancreas and on the duodenal groove with an obstruction of the minor papilla. Patients are mainly men, with chronic alcohol and tobacco intake. They present with abdominal pain, vomiting and weight loss. Association with chronic pancreatitis is present in 60 to 70% of cases. The paraduodenal pancreatitis can also occur in the absence of exogenous factors. Combination of CT-scan, MRI and endoscopic ultrasound ensure the positive diagnosis displaying an inflammatory thickening of the upper part of the second duodenum in which one or more cysts are located. Both lesions can induce a duodenal stenosis. In addition, there are inflammatory and cystic lesions of the duodenal groove and the head of the pancreas. The main differential diagnoses are: pancreatic cancer, pseudo-cysts and IPMN. Medical treatment aims to treat vomiting, dehydration, malnutrition and pain in combination with alcohol and tobacco withdrawal. Endoscopic ultrasound-guided needle aspiration of the duodenal cysts is effective, but often temporarily. Surgical treatment consists in a Whipple pancreatic resection procedure. Nowadays, it is indicated in patients with a failure of medical treatment and in case of diagnostic doubt, especially with pancreatic adenocarcinoma.

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