D0081 - Gastric Outlet Obstruction Caused by Groove Pancreatitis

Andrea Fernandez, MD, Mahum Nadeem, MD, Nikhil Bachoo, MD
University of Oklahoma Health Sciences Center, Oklahoma City, OK

Introduction: Paraduodenal or groove pancreatitis is a rare form of chronic pancreatitis. Anatomically it involves the area between the pancreatic head, duodenal wall, and common bile duct, also known as the pancreatic-duodenal groove. Symptoms include abdominal pain, nausea, vomiting, and weight loss. We present a case of a middle-aged man diagnosed with groove pancreatitis complicated by gastric outlet obstruction (GOO).

Case Description/Methods: 62-year-old male with PMH of HTN, HLD, peripheral vascular disease, COPD, chronic alcohol and tobacco use disorder presented with 4-week history of burning epigastric pain, nausea, and vomiting. In addition, he had a 20-pound weight loss over the past few months and a history of recurrent alcoholic pancreatitis. Lipase on admission was 695. CT abdomen/pelvis showed a dilated stomach consistent with GOO to the level of the pyloric channel, cystic area along the first portion of the duodenal wall and mild fat stranding around pancreatic head. Initial differential included perforation secondary to peptic ulcer disease vs. malignancy as the underlying cause of obstruction. GI was consulted given concern for duodenal malignancy, but further review of imaging correlated with groove pancreatitis resulting in GOO. Patient was managed conservatively and obstruction was treated with a PEG-J tube.

Discussion: Groove pancreatitis was first described in 1970s as an uncommon form of chronic pancreatitis localized to the pancreaticoduodenal groove. It is commonly seen in middle aged men and is strongly associated with alcohol and tobacco use. The underlying etiology is not well understood but is thought to involve anatomical or structural obstruction. One theory suggests alcohol and tobacco increases the viscosity of the pancreatic juice leading to impaired outflow. CT with contrast and MRI is used primarily for diagnosis. Characteristic imaging findings include cystic lesions in the duodenal wall, dilation of Santorini’s duct, or hyperplasia of Brunner’s gland. Treatment involves conservative management with pain control and nutritional support. Pancreatoduodenectomy is an option if symptoms do not resolve. Complications such as GOO can be treated initially with decompression via nasogastric tube followed by PEG-J placement for venting and post pancreatic enteral feeds. Although groove pancreatitis is rare, timely diagnosis based on imaging is essential to ensure appropriate management and to avoid unnecessary workup of other, more serious causes of GOO such as malignancy.


Disclosures:


Andrea Fernandez, MD, Mahum Nadeem, MD, Nikhil Bachoo, MD. D0081 - Gastric Outlet Obstruction Caused by Groove Pancreatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.