DIAGNOSTIC CHALLENGES IN GROOVE PANCREATITIS

CONTEXT Groove pancreatitis often masquerades as pancreatic carcinoma. Clinically groove pancreatitis and pancreatic carcinoma shares many common features. These uncommon pancreatic diseases with challenging imaging diagnosis can lead to surgical dilemma. The purpose of the study is to report the surgical dilemma in two cases presenting with pancreatitis and obstructive jaundice, and to review the current clinical radiological and pathological characterisation of pancreatic carcinoma and groove pancreatitis. CASE REPORT Two different cases presented with chronic abdominal pain with acute exacerbation, associated with nausea, vomiting and features of obstructive jaundice. They had similar clinical, radiological and pathological findings. A CT abdomen of them revealed hypodense mass lesion in the periampullary region for both. MRCP also shows similarity with paraduodenal wall cyst suggesting groove pancreatitis. Here, the surgical dilemma occurs with case 1, who has constantly progressive obstructive jaundice and elevated CA 19-9 values, highly suspicious of malignancy, hence proceeded with wipples surgery. Surprisingly the histopathology turned out to be inflammatory. Case 2 was managed conservatively with proton pump inhibitors and supportive measures alone. CONCLUSION Groove pancreatitis often masquerades as pancreatic carcinoma. Several studies have been attempted to clarify the difference between carcinoma and pancreatitis in the groove area. The discrimination has been proved difficult considering only the imaging report of parduodenal wall cyst and obstructive jaundice clinically. Definitive diagnosis can be obtained after surgical intervention in some. This should be considered when making differential diagnosis in pancreatic groove pathology and duodenal stenosis.