| Abstrakt: |
Background: Groove pancreatitis (GP) is a rare form of chronic pancreatitis affecting the “groove” between the pancreatic head, duodenum, and common bile duct, characterized by fibrotic scarring. Its etiology is unknown; however, it more frequently appears in males with long-term smoking and alcohol abuse. Aim: This case report stands as a reminder to always keep in mind less common differential diagnoses of obvious presentations. Case Report: A 52-year-old male smoker with no history of alcohol abuse presented with complaints of abdominal pain in epigastric region spreading to his back, acholic stool and darker urine. Blood analysis revealed elevated amylase (225 U/L) and lipase (1090 U/L) as well as cholestasis (bilirubin 127 µmol /L, AP 297 U/L, GGT 1970 U/L). Initial ultrasound showed a dilated intrahepatic bile ducts and common bile duct, while the pancreas was not detectable. A CT scan found a well-defined predominantly hypodense mass in the pancreatoduodenal groove that narrowed the duodenum. Due to obstructive icterus, during the diagnostic ERCP, biliary sphincterotomy and implantation of biliary stent were made, resulting in adequate biliary drainage. Brush samples from duodenum around papilla minor showed acute inflammatory process and no signs of tumor, which along with previous imaging and normal levels of tumor markers CEA and CA 19-9 led to the diagnosis of groove pancreatitis. Conclusion: The differential diagnosis of GP may vary from anatomic variants to malignancies. The most relevant diagnosis is adenocarcinoma of the head of the pancreas. Clinical diagnosis of GP is challenging and the potential to fail in distinguishing it from other more common causes of recurrent pancreatitis, including malignancies is always present. [ABSTRACT FROM AUTHOR] |
