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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.

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Related in: MedlinePlus

Duodenoscopy. Patient 47 y.o. Duodenal dystrophy. Cyst embedded in the medial wall of duodenum causing intrinsic contour bulge.
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fig11: Duodenoscopy. Patient 47 y.o. Duodenal dystrophy. Cyst embedded in the medial wall of duodenum causing intrinsic contour bulge.

Mentions: The use of various procedures is given in Table 3. Abdominal ultrasound and computed tomography with intravenous contrast as well as esophagogastroduodenoscopy were performed in all patients. Only in two cases, duodenal dystrophy was suspected based on transabdominal ultrasound findings. In all cases, intrinsic contour bulge of the medial duodenal wall into the lumen was found (Figure 11), and it was associated with significant duodenal stenosis in 21 (33.6%) patients. In three patients (4.8%), the duodenal portion downstream stenosis could not be reached by the endoscope. In 20 (32%) patients, the following conditions were also found: erosive esophagitis in 11 (17.6%) patients, erosive and ulcerative duodenitis in 7 (11.2%), and erosive gastritis in 12 (19.2%) patients. X-ray examination of the stomach showed evidence of severe stenosis with stomach dilation in 8 (12.8%) patients (Figure 12).


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)

Duodenoscopy. Patient 47 y.o. Duodenal dystrophy. Cyst embedded in the medial wall of duodenum causing intrinsic contour bulge.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig11: Duodenoscopy. Patient 47 y.o. Duodenal dystrophy. Cyst embedded in the medial wall of duodenum causing intrinsic contour bulge.
Mentions: The use of various procedures is given in Table 3. Abdominal ultrasound and computed tomography with intravenous contrast as well as esophagogastroduodenoscopy were performed in all patients. Only in two cases, duodenal dystrophy was suspected based on transabdominal ultrasound findings. In all cases, intrinsic contour bulge of the medial duodenal wall into the lumen was found (Figure 11), and it was associated with significant duodenal stenosis in 21 (33.6%) patients. In three patients (4.8%), the duodenal portion downstream stenosis could not be reached by the endoscope. In 20 (32%) patients, the following conditions were also found: erosive esophagitis in 11 (17.6%) patients, erosive and ulcerative duodenitis in 7 (11.2%), and erosive gastritis in 12 (19.2%) patients. X-ray examination of the stomach showed evidence of severe stenosis with stomach dilation in 8 (12.8%) patients (Figure 12).

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