title: Pancreaticoduodenectomy as the primary therapeutic choice in cystic dystrophy of the duodenal wall in heterotopic pancreas.
abstract: 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.
authors.affiliation: Department of General, Geriatric Oncological Surgery and Advanced Technology, University of Naples "Federico II", School of Medicine, Naples.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galloro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Napolitano
authors.forename: Luca
authors.initials: L
authors.lastname: Magno
authors.forename: Giorgio
authors.initials: G
authors.lastname: Diamantis
authors.forename: Antonio
authors.initials: A
authors.lastname: Pastore
authors.forename: Francesca
authors.initials: F
authors.lastname: Mosella
authors.forename: Mario
authors.initials: M
authors.lastname: Donisi
authors.forename: Simona
authors.initials: S
authors.lastname: Ruggiero
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pascariello
authors.forename: Marika
authors.initials: M
authors.lastname: Bruno
authors.forename: Giovanni
authors.initials: G
authors.lastname: Persico
mesh_terms: 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