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Cystic dystrophy in heterotopic pancreas.

C de Ponthaud1, E Daire2, M Pioche2

  • 1Department of hepatobiliary and pancreatic surgery and liver transplantation, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Department of general, visceral and endocrine surgery, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Sorbonne university, Paris, France.

Journal of Visceral Surgery
|March 25, 2023
PubMed
Summary

Paraduodenal pancreatitis, a rare condition involving heterotopic pancreas in the duodenal wall, primarily affects middle-aged men. Conservative treatment offers symptomatic relief in 57% of cases, while surgery provides higher regression rates but with increased complications.

Keywords:
Cystic dystrophy in heterotopic pancreasDuodenal resection with pancreatic preservationPancreatic cystParaduodenal pancreatitispancreaticoduodenectomy

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Area of Science:

  • Gastroenterology
  • Pathology
  • Surgical Oncology

Background:

  • Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare condition affecting the duodenal wall.
  • It is more prevalent in middle-aged men with a history of alcohol abuse and chronic pancreatitis.
  • The condition can be purely duodenal or segmental (pancreatico-duodenopathy).

Purpose of the Study:

  • To describe the pathophysiology, clinical presentation, and imaging findings of paraduodenal pancreatitis.
  • To evaluate the efficacy and complication rates of conservative, endoscopic, and surgical treatments.
  • To compare different surgical approaches, including pancreaticoduodenectomy and pancreatic-preserving duodenal resection (PPDR).

Main Methods:

  • Review of clinical cases and imaging findings (e.g., wall thickening, cysts).
  • Analysis of treatment outcomes for conservative (medical, endoscopic) and surgical interventions.
  • Comparison of surgical techniques such as pancreaticoduodenectomy and PPDR.

Main Results:

  • Conservative medical treatment achieved symptomatic regression in 57% of cases with a 5% complication rate.
  • Surgical intervention resulted in 79% symptom regression but carried a 20% complication rate.
  • PPDR is highlighted as an effective treatment, particularly for purely duodenal forms, potentially preventing segmental progression.

Conclusions:

  • A stepwise therapeutic approach is recommended, favoring conservative measures initially.
  • Surgery is reserved for therapeutic failures or diagnostic uncertainty regarding malignancy.
  • PPDR represents a promising surgical option for paraduodenal pancreatitis, especially in its early stages.