Zahir Soonawalla

Groove pancreatitis is a rare condition characterized by fibrotic inflammation affecting the groove anatomical area between the head of the pancreas, the duodenum and the common bile duct. We report a miniseries of five cases treated surgically in our centre over a period of four years. A review of the literature is also discussed. Patients undergoing pancreaticoduodenectomy over a four-year period were retrospectively reviewed. Patients with a confirmed histological diagnosis of groove pancreatitis were assessed under the headings; patient demographics, presenting symptoms, radiological and histological findings. One-hundred and 60 pancreaticoduodenectomies were performed. Thirty-nine cases demonstrated benign disease and within this, five cases (3.1% of total series; 12.8% of benign cases) were groove pancreatitis. All patients presented with abdominal pain and weight loss, and the majority consumed excess alcohol and were smokers. Radiological findings (CT/MRCP/EUS) revealed duodenal wall thickening in all cases, abnormalities at the head of pancreas and bile duct dilation in four, and cystic changes in the duodenal wall and pancreatic duct dilation in three cases. Groove fibrosis, Brunner's gland hyperplasia and cystic changes in duodenal wall were present in all cases on histological review. All patients reported significant improvement in quality of life at 12 months after surgery. Groove pancreatitis can present in a similar fashion to head of pancreas cancer and chronic pancreatitis. For this reason it is paramount for clinicians to be aware of groove pancreatitis, as this can lead to the correct diagnosis and management of this unique disease.

Pancreatic surgeons need to be aware of, and have the expertise available to deal with, unexpected vascular anomalies encountered during pancreatic resections. We present a patient with celiac artery occlusion that was encountered unexpectedly during pancreaticoduodenectomy. As a result of this anomaly, the celiac territory is dependent on retrograde flow via collaterals from the superior mesenteric artery. We discuss the method of identifying this situation, and of revascularising the celiac trunk to prevent ischaemia of upper abdominal viscera. We highlight the implications for surgical training.