Groove pancreatitis presenting as gastric outlet obstruction with phytobezoar: a diagnostic challenge

Nabeela Tazeen; Tamar Ratiani; Purna C. Paidi; Siddharth P. Revankar; Shrivatsam Paidi

doi:10.18203/issn.2454-2156.IntJSciRep20260038

Authors

Nabeela Tazeen Dr. V. R. K. Women's Medical College, Telangana, India
Tamar Ratiani David Tvildiani Medical University, Tbilisi, Georgia
Purna C. Paidi Andhra Medical College, Andhra Pradesh, India
Siddharth P. Revankar Gadag Institute of Medical Sciences, Karnataka, India
Shrivatsam Paidi Government Medical College, Srikakulam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2454-2156.IntJSciRep20260038

Keywords:

Groove pancreatitis, Gastric outlet obstruction, Phytobezoar, Duodenal ulcer, Pancreatic enzyme replacement

Abstract

A 61-year-old man presented with three months of persistent vomiting of undigested food, marked weight loss, and melena, with a history of long-standing dyspepsia. Initial imaging demonstrated a mass at the gastroduodenal junction, raising concern for malignancy, but further evaluation revealed features consistent with groove pancreatitis, including duodenal wall thickening, pancreatoduodenal groove changes, and a bulky pancreatic head. Endoscopy identified a large gastric phytobezoar complicating gastric outlet obstruction, which was removed endoscopically. Conservative management with pancreatic enzyme replacement, nutritional supplementation, and proton pump inhibitor therapy led to clinical improvement. This case underscores the diagnostic difficulty in differentiating groove pancreatitis from malignancy and highlights the value of non-surgical management in selected patients.

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References

Becker V. Spezielle pathologische Anatomie. Berlin. Cham, Switzerland: Springer Nature Switzerland AG. Bauchspeicheldrüse Inselapparat Ausgenommen. 1973;252:445. DOI: https://doi.org/10.1007/978-3-642-65409-1_12

Stolte M, Weiss W. A special form of segmental pancreatitis: groove pancreatitis. Hepatogastroenterology. 1982;29:198208.

Becker V, Mischke U. Groove pancreatitis. Int J Pancreatol. 1991;10:173-82. DOI: https://doi.org/10.1007/BF02924155

Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying “cystic dystrophy of heterotopic pancreas”, “para-duodenal wall cyst”, and “groove pancreatitis”. Semin Diagn Pathol. 2005;21:247-54. DOI: https://doi.org/10.1053/j.semdp.2005.07.005

Zamboni G, Capelli P, Scarpa A, Bogina G, Pesci A, Brunello E, et al. Nonneoplastic mimickers of pancreatic neoplasms. Arch Pathol Lab Med. 2009;133:439-53. DOI: https://doi.org/10.5858/133.3.439

Manzelli A, Petrou A, Lazzaro A. Groove pancreatitis: a mini-series report and review of the literature. JOP. 2011;12:230-3.

Shudo R, Yazaki Y, Sakurai S, Uenishi H, Yamada H, Sugawara K, et al. Groove pancreatitis: report of a case and review of the clinical and radiologic features of groove pancreatitis reported in Japan. Intern Med. 2002;41(7):537-42. DOI: https://doi.org/10.2169/internalmedicine.41.537

Yamaguchi K, Tanaka M. Groove pancreatitis masquerading as pancreatic carcinoma. Am J Surg. 1992;163:312-6. DOI: https://doi.org/10.1016/0002-9610(92)90009-G

Ray S, Ghatak S, Misra D, Dasgupta J, Biswas J, Khamrui S, et al. Groove Pancreatitis: Report of Three Cases with Brief Review of Literature. Indian J Surg. 2017;79(4):344-8. DOI: https://doi.org/10.1007/s12262-017-1643-x

Blasbalg R, Baroni RH, Costa DN, Machado MC. MRI features of groove pancreatitis. AJR Am J Roentgenol. 2007;189:73-80. DOI: https://doi.org/10.2214/AJR.06.1244

Iglesias García J, Lariño Noia J, Domínguez Muñoz JE. Endoscopic ultrasound in the diagnosis and staging of pancreatic cancer. Rev Esp Enferm Dig. 2009;101:631-8. DOI: https://doi.org/10.4321/S1130-01082009000900006

Gabata T, Kadoya M, Terayama N, Sanada J, Kobayashi S, Matsui O. Groove pancreatic carcinomas: radiological and pathological findings. Eur Radiol. 2003;13:1679-84. DOI: https://doi.org/10.1007/s00330-002-1743-1

Chantarojanasiri T, Isayama H, Nakai Y, Matsubara S, Yamamoto N, Takahara N, et al. Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology. Gut Liver. 2018;12(2):208-13. DOI: https://doi.org/10.5009/gnl17170

Isayama H, Kawabe T, Komatsu Y, Sasahira N, Toda N, Tada M, et al. Successful treatment for groove pancreatitis by endoscopic drainage via the minor papilla. Gastrointest Endosc. 2005;61(1):175-8. DOI: https://doi.org/10.1016/S0016-5107(04)02460-5

Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M, et al. “Paraduodenal” pancreatitis: results of surgery on 58 consecutive patients from a single institution. World J Surg. 2009;33(12):2664-9. DOI: https://doi.org/10.1007/s00268-009-0238-5