Pancreas-Preserving Approach to “Paraduodenal Pancreatitis” Treatment: Why, When, and How? Experience of Treatment of 62 Patients with Duodenal Dystrophy
Figure 13
Duodenal dystrophy with moderate chronic orthotopic pancreatitis. Multidetector computed tomography. Frontal view. Patient, 32 y.o. (a) Arterial phase. Deformation and thickening of the medial wall of the duodenum with septated cyst (arrow). The gastroduodenal artery is shifted forward and to the left, lying in the groove between the pancreatic head and affected duodenal wall (arrowhead). The scheme of the lesion and the unaffected main pancreas is in the lower right corner; (b) patient 44 y.o. Venous phase. Deformed and thickened medial duodenal wall with multiple cysts (arrow), separated from moderately changed pancreatic head (thick arrow), is narrowing the duodenal lumen (arrowhead). The scheme of the lesion and the unaffected main pancreas is in the lower right corner; (c) patient 49 y.o. Arterial phase. Deformation and thickening of the medial wall of the duodenum with contrasted pancreatic tissue inside (arrow). The gastroduodenal artery is shifted forward and to the left, lying in the groove between the pancreatic head and affected duodenal wall (black arrow). The scheme of the lesion and the unaffected main pancreas is in the upper right corner. (d) Isolated form of the duodenal dystrophy. Multidetector computed tomography. (d) Male, 57 y.o. Arterial phase. Sagittal view. Deformation and thickening of the medial wall of the duodenum (D) with septated cysts (DD). The gastroduodenal artery (GDA) is shifted forward and to the left, lying in the groove between the unaffected pancreatic head (P) and duodenal wall. (e) Isolated form of the duodenal dystrophy with unchanged orthotopic pancreas. (a) Male 57 y.o. Arterial phase. Sagittal view. Septated cysts in the submucosa and muscularis of the diffusely thickened duodenal wall surround the major papilla.
