Groove pancreatitis: report of one case in Thailand

Groove pancreatitis is a rare form of chronic pancreatitis affecting the head of the pancreas localized within the pancreatoduodenal groove. Fibrous scar in this specific topography sometimes makes it hard to differentiate from pancreatic cancer preoperatively. The author reports the case of a 44-year-old man with a long history of alcoholic abuse and experienced intermittent epigastric and nausea vomiting for 2 years. Abdominal ultrasound showed an irregular mixed echogenic mass at the pancreatic head. A computed tomography revealed a poorly enhanced solid mass with small low density cystic areas in the groove, thickening and luminal narrowing of the descending part of the duodenum. Magnetic resonance imaging demonstrated the same mass that was hypointense on T1 weighted images, isointense on T2 weighted images and delayed, progressive inhomogeneous enhancement on dynamic contrast study. MRCP defined a prominent smooth tapering of the common bile duct. Endoscopy disclosed an inflammed sessile mass at the second part of the duodenum. Microscopic examination of the biopsy specimens suggested only chronic inflammation. Then, the patient was treated conservatively and evaluated periodically.