Limits...
Pancreas-preserving approach to "paraduodenal pancreatitis" treatment: why, when, and how? Experience of treatment of 62 patients with duodenal dystrophy.

Egorov VI, Vankovich AN, Petrov RV, Starostina NS, Butkevich ATs, Sazhin AV, Stepanova EA - Biomed Res Int (2014)

Bottom Line: To assess the results of different types of treatment for PP.Prospective analysis of 62 cases of PP (2004-2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded.  Preoperative diagnosis was correct in all the cases except one (1.9%).PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not "paraduodenal," origin.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Moscow City Hospital No. 5, Sechenov First Moscow State Medical University, Stromynka Street 7, Moscow 107076, Russia.

ABSTRACT

Background: The term "paraduodenal pancreatitis" (PP) was proposed as a synonym for duodenal dystrophy (DD) and groove pancreatitis, but it is still unclear what organ PP originates from and how to treat it properly.

Objective: To assess the results of different types of treatment for PP.

Method: Prospective analysis of 62 cases of PP (2004-2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded. 

Results: Preoperative diagnosis was correct in all the cases except one (1.9%). Patients presented with abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Ten patients were treated conservatively, 24 underwent pancreaticoduodenectomies (PD), pancreatico- and cystoenterostomies (8), Nakao procedures (5), duodenum-preserving pancreatic head resections (5), and 10 pancreas-preserving duodenal resections (PPDR) without mortality. Full pain control was achieved after PPRDs in 83%, after PDs in 85%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD.

Conclusions: PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not "paraduodenal," origin.

Show MeSH

Related in: MedlinePlus

Removed pancreaticoduodenal specimen. (a) Patient 53 y.o. Duodenal dystrophy with chronic orthotopic pancreatitis. Ectopic pancreas within the medial wall of the duodenum (arrow) 1 cm from the main duodenal papilla (wide arrow) with a probe passed through the common bile duct and pancreatic duct; (b) and (c) macrophotograph. Section through the ectopic pancreas. The duodenal wall (arrow) separates the ectopic gland (wide arrow) and the head of the orthotopic pancreas (asterisk) with severe chronic inflammation. The ampulla of Vater (arrowhead) is 0.5 cm from the heterotopic gland; (d) patient 43 y.o. Duodenal dystrophy with moderate chronic pancreatitis in the main pancreas. The probe is passed through the ampulla of Vater. Septated cysts 0.5–1.5 cm in diameter (triple arrow) in the duodenal wall are isolated from the head of pancreas; (e) patient 34 y.o. Duodenal dystrophy with moderate chronic pancreatitis in the main pancreas (asterisk). The second portion of the duodenum is transversely dissected (two-headed arrow). The cyst up to 5 cm in diameter is spread along the whole duodenal wall (triple arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4066689&req=5

fig7: Removed pancreaticoduodenal specimen. (a) Patient 53 y.o. Duodenal dystrophy with chronic orthotopic pancreatitis. Ectopic pancreas within the medial wall of the duodenum (arrow) 1 cm from the main duodenal papilla (wide arrow) with a probe passed through the common bile duct and pancreatic duct; (b) and (c) macrophotograph. Section through the ectopic pancreas. The duodenal wall (arrow) separates the ectopic gland (wide arrow) and the head of the orthotopic pancreas (asterisk) with severe chronic inflammation. The ampulla of Vater (arrowhead) is 0.5 cm from the heterotopic gland; (d) patient 43 y.o. Duodenal dystrophy with moderate chronic pancreatitis in the main pancreas. The probe is passed through the ampulla of Vater. Septated cysts 0.5–1.5 cm in diameter (triple arrow) in the duodenal wall are isolated from the head of pancreas; (e) patient 34 y.o. Duodenal dystrophy with moderate chronic pancreatitis in the main pancreas (asterisk). The second portion of the duodenum is transversely dissected (two-headed arrow). The cyst up to 5 cm in diameter is spread along the whole duodenal wall (triple arrow).

Mentions: In 39 cases, the diagnosis was confirmed by histopathology of the removed pancreaticoduodenal or duodenal specimens. Typically, the ectopic tissue was found in the muscle layer and, when the size of the mass was large enough, also in the submucosal layer of the duodenum in close proximity to and often involving the major duodenal papilla (60 cases) (Figures 7, 8, and 9). The minor duodenal papilla was not detectable in the majority of cases, but clearly discernible outside the pathological lesion in 5 cases. Cysts could be lined with secretory pancreatic epithelium or composed of fibrotic tissue with polymorphic cell infiltration (Figures 9 and 10). When duodenum-preserving pancreatic head resection or draining procedures were performed, pathohistological examination of pancreatic tissue only was possible. A severe chronic “orthotopic” pancreatitis with massive fibrosis and the presence of pseudocysts and/or stones was found in 50 (80.6%) patients; changes in the orthotopic pancreas were moderate in 10 (16%) patients and mild in two cases (3.2%).


Pancreas-preserving approach to "paraduodenal pancreatitis" treatment: why, when, and how? Experience of treatment of 62 patients with duodenal dystrophy.

Egorov VI, Vankovich AN, Petrov RV, Starostina NS, Butkevich ATs, Sazhin AV, Stepanova EA - Biomed Res Int (2014)

Removed pancreaticoduodenal specimen. (a) Patient 53 y.o. Duodenal dystrophy with chronic orthotopic pancreatitis. Ectopic pancreas within the medial wall of the duodenum (arrow) 1 cm from the main duodenal papilla (wide arrow) with a probe passed through the common bile duct and pancreatic duct; (b) and (c) macrophotograph. Section through the ectopic pancreas. The duodenal wall (arrow) separates the ectopic gland (wide arrow) and the head of the orthotopic pancreas (asterisk) with severe chronic inflammation. The ampulla of Vater (arrowhead) is 0.5 cm from the heterotopic gland; (d) patient 43 y.o. Duodenal dystrophy with moderate chronic pancreatitis in the main pancreas. The probe is passed through the ampulla of Vater. Septated cysts 0.5–1.5 cm in diameter (triple arrow) in the duodenal wall are isolated from the head of pancreas; (e) patient 34 y.o. Duodenal dystrophy with moderate chronic pancreatitis in the main pancreas (asterisk). The second portion of the duodenum is transversely dissected (two-headed arrow). The cyst up to 5 cm in diameter is spread along the whole duodenal wall (triple arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4066689&req=5

fig7: Removed pancreaticoduodenal specimen. (a) Patient 53 y.o. Duodenal dystrophy with chronic orthotopic pancreatitis. Ectopic pancreas within the medial wall of the duodenum (arrow) 1 cm from the main duodenal papilla (wide arrow) with a probe passed through the common bile duct and pancreatic duct; (b) and (c) macrophotograph. Section through the ectopic pancreas. The duodenal wall (arrow) separates the ectopic gland (wide arrow) and the head of the orthotopic pancreas (asterisk) with severe chronic inflammation. The ampulla of Vater (arrowhead) is 0.5 cm from the heterotopic gland; (d) patient 43 y.o. Duodenal dystrophy with moderate chronic pancreatitis in the main pancreas. The probe is passed through the ampulla of Vater. Septated cysts 0.5–1.5 cm in diameter (triple arrow) in the duodenal wall are isolated from the head of pancreas; (e) patient 34 y.o. Duodenal dystrophy with moderate chronic pancreatitis in the main pancreas (asterisk). The second portion of the duodenum is transversely dissected (two-headed arrow). The cyst up to 5 cm in diameter is spread along the whole duodenal wall (triple arrow).
Mentions: In 39 cases, the diagnosis was confirmed by histopathology of the removed pancreaticoduodenal or duodenal specimens. Typically, the ectopic tissue was found in the muscle layer and, when the size of the mass was large enough, also in the submucosal layer of the duodenum in close proximity to and often involving the major duodenal papilla (60 cases) (Figures 7, 8, and 9). The minor duodenal papilla was not detectable in the majority of cases, but clearly discernible outside the pathological lesion in 5 cases. Cysts could be lined with secretory pancreatic epithelium or composed of fibrotic tissue with polymorphic cell infiltration (Figures 9 and 10). When duodenum-preserving pancreatic head resection or draining procedures were performed, pathohistological examination of pancreatic tissue only was possible. A severe chronic “orthotopic” pancreatitis with massive fibrosis and the presence of pseudocysts and/or stones was found in 50 (80.6%) patients; changes in the orthotopic pancreas were moderate in 10 (16%) patients and mild in two cases (3.2%).

Bottom Line: To assess the results of different types of treatment for PP.Prospective analysis of 62 cases of PP (2004-2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded.  Preoperative diagnosis was correct in all the cases except one (1.9%).PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not "paraduodenal," origin.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Moscow City Hospital No. 5, Sechenov First Moscow State Medical University, Stromynka Street 7, Moscow 107076, Russia.

ABSTRACT

Background: The term "paraduodenal pancreatitis" (PP) was proposed as a synonym for duodenal dystrophy (DD) and groove pancreatitis, but it is still unclear what organ PP originates from and how to treat it properly.

Objective: To assess the results of different types of treatment for PP.

Method: Prospective analysis of 62 cases of PP (2004-2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded. 

Results: Preoperative diagnosis was correct in all the cases except one (1.9%). Patients presented with abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Ten patients were treated conservatively, 24 underwent pancreaticoduodenectomies (PD), pancreatico- and cystoenterostomies (8), Nakao procedures (5), duodenum-preserving pancreatic head resections (5), and 10 pancreas-preserving duodenal resections (PPDR) without mortality. Full pain control was achieved after PPRDs in 83%, after PDs in 85%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD.

Conclusions: PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not "paraduodenal," origin.

Show MeSH
Related in: MedlinePlus