Clinicoradiological appraisal of ′paraduodenal pancreatitis′: Pancreatitis outside the pancreas!

Ankur Arora; S Rajesh; Amar Mukund; Yashwant Patidar; Shalini Thapar; Asit Arora; Vikram Bhatia

doi:10.4103/0971-3026.161467

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(03): 303-314
DOI: 10.4103/0971-3026.161467

Abdominal Radiology

Clinicoradiological appraisal of ′paraduodenal pancreatitis′: Pancreatitis outside the pancreas!

Ankur Arora

Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

,

S Rajesh

Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

,

Amar Mukund

Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

,

Yashwant Patidar

Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

,

Shalini Thapar

Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

,

Asit Arora

Department of Hepato-pancreatico-biliary surgery, Institute of Liver and Biliary Sciences, New Delhi, India

,

Vikram Bhatia

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

› Author Affiliations

Abstract

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Abstract

Purpose: Paraduodenal pancreatitis (PP) is a unique form of focal chronic pancreatitis that selectively involves the duodenum and aberrant pancreatic tissue located near the minor papilla (beyond the pancreas proper). The pseudotumoral nature of the disease often generates considerable clinical quandary and patient apprehension, and therefore merits a better understanding. The present study appraises the clinicoradiological manifestations of PP in 33 patients. Materials and Methods: Clinical, laboratory, and radiological manifestations of 33 patients of PP treated in gastroenterology/hepatology and hepato-pancreatico-biliary surgery units during June 2010-August 2014 were retrospectively reviewed. Results: All patients were young to middle-aged men (100%) with history of alcohol abuse (93.9%) and/or smoking (42.4%), who presented either with acute or gradually worsening abdominal pain (90.9%). Pancreatic enzymes and serum tumor markers remained normal or were mildly/transiently elevated. Cystic variant was detected in 57.6% (solid in 42.4%); the disease remained confined to the groove/duodenum (pure form) in 45.4%. Medial duodenal wall thickening with increased enhancement was seen in 87.87 and 81.81%, respectively, and duodenal/paraduodenal cysts were seen in 78.78%. Pancreatic calcifications and biliary stricture were seen 27.3% patients. Peripancreatic arteries were neither infiltrated nor encased. Conclusion: PP has a discrete predilection for middle-aged men with history of longstanding alcohol abuse and/or smoking. Distinguishing imaging findings include thickening of the pancreatic side of duodenum exhibiting increased enhancement with intramural/paraduodenal cysts. This may be accompanied by plate-like scar tissue in the groove region, which may simulate groove pancreatic carcinoma. However, as opposed to carcinoma, the peripancreatic arteries are neither infiltrated nor encased, rather are medially displaced.

Keywords

Chronic pancreatitis - computed tomography - magnetic resonance imaging - pancreatitis

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References

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