Differential diagnosis and treatment of groove pancreatitis
DOI:
https://doi.org/10.11603/2414-4533.2017.3.8129Keywords:
groove pancreatitis, chronic pancreatitis, differential diagnosis, surgical treatment, pancreatic adenocarcinoma.Abstract
The urgency of the problem in diagnosis and surgical treatment of complicated groove pancreatitis increases due to its similarity to the clinical and instrumental semiotics of the ductal adenocarcinoma of the pancreas in early stages. Differentiation of paraduodenal pancreatitis with malignant diseases of the periampular zone requires a comprehensive survey. The aggregate of the results of specific laboratory and instrumental methods of examination allow only accurate the diagnosis in 75 % of patients. It requires the search of new diagnostic algorithms. Standard pre-operative diagnostics should include: CT, MRI, MRCP and EUS with biopsy. Endoscopic ultrasonography with biopsy and subsequent cytological examination, despite its diagnostic value, does not allow the excluding of the malignant neoplasm of the periampullary region. Only the final histopathological examination of the material verifies groove pancreatitis. In tactics of choosing the surgical treatment, the arsenal of surgical interventions ranges from PDD to pancreas-preserving resections of the duodenum. Based on the pathogenesis and morphological substrate of the disease, European pancreatic centers prefer proximalisolated resections of the pancreas. They showed the best, in comparison with PDR, immediate and long-term results of treatment. In case of suspected malignant pancreatic tumor and / or presence of local complications of groove pancreatitis, the optimal surgical intervention is pancreatoduodenal resection. It finally verifies the diagnosis and eliminate the clinical manifestations of the disease, which in future will improve the patient’s quality of life.
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