Cystic dystrophy in heterotopic pancreas

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.