Pancreaticoduodenectomy as the primary therapeutic choice in cystic dystrophy of the duodenal wall in heterotopic pancreas.
On the basis of a review of the literature and description of a clinical case, the aim of this paper was to evaluate the role of pancreaticoduodenectomy as the primary therapeutic choice in a rare, serious condition such as cystic dystrophy of the duodenal wall in heterotopic pancreas. The diagnosis is difficult because of the non-specific clinical manifestations, and radiological and endoscopic imaging are decisive. Computed tomography and magnetic resonance are very useful for demonstrating the presence of cysts in a thickened duodenal wall but endoscopic ultrasonography is the most useful imaging examination. The choice of therapeutic option is still debated. Although some Authors have proposed a medical approach using octreotide or endoscopic treatment for selected patients, pancreaticoduodenectomy is usually proposed for symptomatic patients. When surgery is needed, pancreaticoduodenectomy should be preferred, reserving by-pass procedures for high-risk patients. Because of the non-specific clinical manifestations and the very difficult diagnostic and therapeutic management, these patients need to be studied and treated in specialised, dedicated centres.
Galloro
Giuseppe
G
Department of General, Geriatric Oncological Surgery and Advanced Technology, University of Naples "Federico II", School of Medicine, Naples.
Napolitano
Vincenzo
V
Magno
Luca
L
Diamantis
Giorgio
G
Pastore
Antonio
A
Mosella
Francesca
F
Donisi
Mario
M
Ruggiero
Simona
S
Pascariello
Annalisa
A
Bruno
Marika
M
Persico
Giovanni
G
D000328:Adult; D002828:Choristoma / Q000150:complications / Q000601:surgery*; D018291:Cystadenoma, Mucinous / Q000150:complications / Q000601:surgery; D003560:Cysts / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004378:Duodenal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010179:Pancreas; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000150:complications / Q000601:surgery; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome