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BioMed Research International
Volume 2014 (2014), Article ID 185265, 17 pages
http://dx.doi.org/10.1155/2014/185265
Clinical Study

Pancreas-Preserving Approach to “Paraduodenal Pancreatitis” Treatment: Why, When, and How? Experience of Treatment of 62 Patients with Duodenal Dystrophy

1Department of Surgical Oncology, Moscow City Hospital No. 5, Sechenov First Moscow State Medical University, Stromynka Street 7, Moscow 107076, Russia
2Hepatopancreatobiliary Department, Vishnevsky Institute of Surgery, Bolshaya Serpukhovskaya Street 27, Moscow 117997, Russia
3General Surgery Department, Central Hospital of FSS RF, Petrovskoye Schosse 48, Golitsino, Moscow 143040, Russia
4General Surgery Department, Moscow City Hospital No. 4, N. Pirogov Russian National Research Medical University, Ostrovityanova Street 1, Moscow 117513, Russia
5Department of Pathology, Moscow City Hospital No. 12, Bakinskaya Street 26, Moscow 115516, Russia

Received 13 January 2014; Accepted 11 May 2014; Published 5 June 2014

Academic Editor: Masahiko Hirota

Copyright © 2014 V. I. Egorov et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.