Hospital admissions from alcohol-related acute pancreatitis during the COVID-19 pandemic: A single-centre study.

BACKGROUND: The United Kingdom government introduced lockdown restrictions for the first time on 23 March 2020 due to coronavirus disease 2019 (COVID-19) pandemic. These were partially lifted on 15 June and further eased on 4 July. Changes in social behaviour, including increased alcohol consumption were described at the time. However, there were no data available to consider the impact of these changes on the number of alcohol-related disease admissions, specifically alcohol-related acute pancreatitis (AP). This study evaluated the trend of alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown. AIM: To evaluate the trend in alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown in the United Kingdom. METHODS: All patients admitted with alcohol-related AP from March to September 2016 to 2020 were considered in this study. Patient demographics, their initial presentation with AP, any recurrent admissions, disease severity and length of stay, were evaluated using ANOVA and χ 2 and Kruskal-Wallis tests. RESULTS: One hundred and thirty-six patients were included in the study. The highest total number of AP admissions was seen in March-September 2019 and the highest single-month period was in March-May 2020. Admissions for first-time presentations of AP were highest in 2020 compared to other year groups and were significantly higher compared to previous years, for example, 2016 (P < 0.05). Furthermore, the rate of admissions decreased by 38.89% between March-May 2020 and June-September 2020 (P < 0.05), coinciding with the easing of lockdown restrictions. This significant decrease was not observed in the previous year groups during those same time periods. Admissions for recurrent AP were highest in 2019. The median length of hospital stay did not differ between patients from each of the year groups. CONCLUSION: An increased number of admissions for alcohol-related AP were observed during months when lockdown restrictions were enforced; a fall in figures was noted when restrictions were eased.

Elective splenectomy in patients with non-Hodgkin lymphoma: Does the size of the spleen affect surgical outcomes?

Backgrounds/Aims: Splenectomy in patients with non-Hodgkin lymphoma (NHL) is performed to relieve abdominal symptoms, treat hypersplenism or confirm diagnosis. Excision of a very large spleen is technically challenging and data on outcomes of surgery in patients with NHL are scanty. The aim of study was to evaluate the impact of spleen size on the surgical outcome of splenectomy in patients with NHL. Methods: Patients with NHL who underwent splenectomy, between 2006 and 2017, were included and divided into two groups: group 1, spleen ≤ 20 cm; group 2, spleen > 20 cm. Surgical approach, operative time, postoperative morbidity, mortality, hospital stay and re-admission rates were retrospectively compared between groups. Non-parametric data were evaluated with the Mann-Whitney U test. Differences in frequencies were analyzed with Fisher's exact test. Results: Sixteen patients were included (group 1, 6; group 2, 10). Laparoscopy was successful in three patients of group 1, none of group 2 (p = 0.035), the intraoperative time did not differ significantly between groups. One patient in each group developed postoperative complications. The patient in group 1 died of pneumonia. Median length of stay was 8 days (range, 3-16 days) for group 1, 5.5 days (range, 3-10 days) for group 2, showing no significant difference between the two groups. No patient was readmitted to hospital. Conclusions: Spleen size does not affect the outcome of splenectomy in patients with NHL. If a mini-invasive approach is to be chosen, laparoscopy may not be feasible when the spleen size is > 20 cm.

Can Preoperative Characteristics Predict the Outcomes of Laparoscopic Cholecystectomy?

Background: Intraoperative findings during laparoscopic cholecystectomy (LC) are highly unpredictable and operative difficulty varies from straightforward to very challenging procedures. Several studies described predictors of technical difficulty and graded intraoperative findings of LC; however, none specifically reported on the effect of such factors on clinical outcomes. This study aims to evaluate if preoperative characteristics of patients undergoing LC predict how likely they are to fail to be day case (DC). Methods: Data of patients who underwent LC from 2015 to 2017 were retrospectively analyzed. Subjects were divided into four groups, according to Nassar's classification of intraoperative difficulty. Differences in frequencies were evaluated with the the chi square and post hoc chi square tests or Fisher's exact test; logistic regression analysis was used to identify independent variables that were predictors of intraoperative complexity, postoperative morbidity, and length of stay. Results: A total of 1043 patient were included with male to female ratio of 1:2.5. Older age, male gender, and comorbidities were associated with higher Nassar score (P < .0001); Nassar 3 and 4 were predictors of postoperative morbidity (P < .05). The DC rate was 74.2% (Nassar 1), 75.8% (Nassar 2), 61.1% (Nassar 3), and 26.2% (Nassar 4), respectively. Age ≥60 years (P < .05), body mass index ≥35 (P < .05), and Nassar 3 and 4 (P < .05) were predictors of increased conversion from DC to inpatient (IP) stay. Conclusion: LC can be safely performed on a DC basis even when surgery is technically challenging. The need of IP stay can be predicted in comorbid old adult men with anticipated higher Nassar's score.

Laparoscopic partial splenectomy using the harmonic scalpel for parenchymal transection: two case reports and review of the literature.

Laparoscopic splenectomy is nowadays widely performed for the treatment of benign and malignant diseases of the spleen. However, removing the spleen increases the risk of postoperative infections, therefore patients need long-life antibiotics. Advancement in surgical technique and instrumentation have led to the development of partial splenectomy, which is mainly indicated to treat localized lesions of the spleen. The main advantage is the preservation of the immune function, so that long-life prescription of antibiotics is no longer needed. The introduction of the laparoscopic approach to laparoscopic splenectomy seems to add further benefits, namely a faster recovery. We report two cases of benign splenic cysts, which were treated by laparoscopic partial splenectomy. Technical aspects on the parenchymal transection and data from the most recent literature are discussed as well.

Does the Implementation of a Clinical Care Pathway Have an Impact on Early Intravenous Fluid Therapy of Acute Pancreatitis?: A Pilot Quality Improvement Study.

OBJECTIVES: Early intravenous fluid (IVF) resuscitation is crucial in the management of acute pancreatitis; variation in IVF prescription practice had been demonstrated. This pilot study aims to assess whether the implementation of an Acute Pancreatitis Care Pathway (APCP) produces a change toward a more adequate IVF regimen in the first 24 hours. METHODS: Patients with confirmed diagnosis of acute pancreatitis, from July 2015 to February 2016 (group 1) and from September 2017 to March 2018 (group 2), were considered. The APCP was developed between March 2016 and August 2017. Median IVF rate, volume, and type infused in the first 24 hours, were compared between groups. Nonparametric data were analyzed with the Mann-Whitney U test, differences in frequencies with the McNemar test; significance was set at P < 0.05. RESULTS: Seventy-two patients were included, 36 in each group. In the first 24 hours, the median IVF rate was 177 mL/h vs 225 mL/h (P = 0.004); Ringer lactate infusion was 30% vs 77.8% (P = 0.0003). The median total IVF volume did not differ between groups. CONCLUSIONS: The implementation of the APCP has the potential to lead to a successful change in early IVF resuscitation practice.

Routine examination of gallbladder specimens after cholecystectomy: a single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma.

BACKGROUND: Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy-this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate and this study evaluates the role of regular specimens' examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC. METHODS: Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student's t-test and ANOVA. RESULTS: Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in six cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease-73.7 [Formula: see text] 5.38 years vs 55.8 [Formula: see text] 0.79 years (p < 0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage-one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression-median survival was 7 months (range 2-14). CONCLUSIONS: In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.

Outcome of acute pancreatitis in octogenarians: A retrospective study.

BACKGROUND AND AIM: Acute pancreatitis (AP) is a common disease, but data on outcomes in octogenarians are scarce in the literature. The aim of this study is to analyze results from patients aged 80 years old and over who were treated for AP at a single center. METHODS: Patients aged 80 years and older diagnosed with AP from April 2010 to October 2015 were considered. Demographics, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), serum biochemistry at 24 and 48 h after admission, and revised Atlanta severity score were analyzed and correlated with hospital mortality rate and length of stay using the multiple regression and Kaplan-Meier tests. RESULTS: A total of 100 consecutive patients were included in the study. There were 52 women, and the mean age was 87.5 years (range 80-95). Gallstones were the most common cause of AP (69.7%). The ASA score was ≥III in 51 patients. Eight patients had severe, disease and all of them died in hospital. A CCI > 4 was associated with higher disease severity and mortality (P < 0.00001). The median hospital stay was 9 days (range 1-59). Longer hospital stay was associated with serum C-reactive protein ≥242 mg/L (P = 0.01) and serum albumin ≤30 g/L (P = 0.01) at 48 h. Over a 5-year period, 22% of patients were readmitted to hospital with recurrent AP. Gallstones were the main cause of disease (63.6%). CONCLUSIONS: AP in octogenarians has low mortality. Higher death rate is associated with disease severity. In the presence of gallstone disease, cholecystectomy is recommended whenever possible as the risk of disease recurrence is significant.

Outcome of Laparoscopic Common Bile Duct Exploration After Failed Endoscopic Retrograde Cholangiopancreatography: A Comparative Study.

Background: Common bile duct stones (CBDS) are treated with endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) or with the single-stage laparoscopic common bile duct exploration (LCBDE) and LC. Multiple ERCP attempts and failure increase the risk of postprocedural complications. In such circumstances surgery is advocated. The aim of the study is to compare the outcome of LCBDE and LC in patients who had never had an ERCP, to that of patients who underwent previously failed ERCP. Methods: A retrospective analysis of 54 patients undergoing LCBDE and LC between 2010 and 2017, was performed. Patients were divided in 2 groups: primary surgery (group 1), surgery after failed ERCP (group 2). Demographics and preoperative investigation results were collected. Comparative outcomes were common bile duct (CBD) clearance rate, operative time, conversion to open rate, postoperative morbidity, mortality, and hospital stay. Data were evaluated with the Student's t, Chi-square, or Fisher's tests. Results were considered as statistically significant when P < .05. Results: In both groups CBD clearance was above 90%. The mean operative time was longer in group 2 (130.3 minutes ± SD 83.72 vs. 178.73 ± 57.22; P < .05). There was no difference in the conversion to open and postoperative complication rates between groups. A bile leak occurred in 2 patients from group 1, 3, from group 2. No postoperative mortality occurred. The median hospital stay was longer in group 2 (2 days ± SD 2.54 vs. 5 ± 5.77; P < .05). Conclusions: LCBDE and LC is safe and effective in patients who had previous failed ERCP. If ERCP failure is anticipated and/or the risk of post-ERCP complications is high, surgery should be considered as the first-line treatment of CBDS. Longer intraoperative time and hospital stay are expected.

The mass effect of a slowly growing GIST.

Gastrointestinal stromal tumours (GISTs) are typically defined as solid masses arising from the GI tract, most commonly from the stomach and small intestine. They seldom present in a cystic form. Management of cystic masses arising from the GI tract may pose a diagnostic predicament. We had one such case that presented itself with complaints of a slow growing intra-abdominal mass. An ultrasound scan demonstrated a thick-walled cystic lesion arising from the pelvis. Further imaging evaluations in the form of a CT scan revealed a complex large cystic mass arising from left upper quadrant (see Figure 1). Due to the uncertainty of origin of this mass and lack of invasion or lymphadenopathy, it was thought to be benign. After a multidisciplinary meeting, it was concluded that an urgent surgical excision of this benign mass was the best treatment. The surgical treatment of which entailed a 10 hours surgery to resect this 10 kg lesion, which comprised 7 L fluid and 3 kg solid mass. Histopathology aided in the diagnosis of this lesion as a CD117-positive and DOG1-positive GIST.

Day case laparoscopic cholecystectomy: Safety and feasibility in obese patients.

INTRODUCTION: Day-case laparoscopic cholecystectomy (DCLC) is not universally adopted and its use is limited to patients selected by non-standardized criteria. Since laparoscopic cholecystectomy is considered technically more difficult in obese patients, a high body mass index (BMI) is often considered an exclusion criterion for DCLC. The aim of this research is to define the feasibility and safety of day case laparoscopic cholecystectomy in obese patients. PRESENTATION OF CASE: Data from 730 consecutive patients preoperatively considered suitable for DCLC were analysed. BMI was not considered as parameter of selection and patients were divided in two groups (Obese, 294; Non-obese, 436) according to a BMI ≥ 30 or < 30 kg/m2, respectively. Outcomes measured were morbidity, open conversion rates, hospitalization rates, length of hospital stay and readmission. Overall morbidity and open conversion rates were similar in both groups. No significant differences were observed among the two groups in terms of hospitalization rates (p 0.0533), early complications (p 0.2536), length of hospital stay (p 0.3780) and readmission rates (p 0.4286). DISCUSSION: Day case laparoscopic cholecystectomy is a widely used surgical technique despite not routinely used in every health system. However, many factors related to the patient and procedure, as well as the expertise of surgical-anesthesiologist team, can influence the feasibility of DCLC. Moreover a well-organized health community system is necessary to protect and follow the patients up. Our readmission and complication rates showed how a day case laparoscopic cholecystectomy, if performed in the right setting, is a safe procedure also for patient with a raised BMI. We enrolled a large population of patients and the statistical analysis demonstrated no significant differences among the obese and non-obese patient regarding the primary and secondary endpoints. CONCLUSIONS: DCLC is a safe and effective procedure in obese patients with morbidity, hospital admission and readmission rates similar to those observed in non-obese patients.

An Unusual Case of Primary Extranodal Lymphoma of the Gallbladder.

Primary gallbladder lymphoma is an extremely rare disease. We report a case of a 63 year-old woman who has been admitted with gradual onset abdominal pain in the upper right quadrant and in the suprapubic region, nausea and malaise. According to the computed tomography scan of the abdomen, which was suggestive of chronic cholecystitis, she was treated conservatively. A laparoscopic cholecystectomy was performed 5 months later and the histological examination of the gallbladder showed a low grade small lymphocytic lymphoma. The patient has been taken over by the hematology team who kept her under surveillance as no further treatment was deemed as necessary. The purpose of this paper is to report a rare case of primary gallbladder lymphoma and to demonstrate that a laparoscopic cholecystectomy may be a valid treatment for this disease.

Anomalous radiological and clinical demonstration of gallbladder duplication in an asymptomatic pregnant female.

Gallbladder duplication is an uncommon congenital anatomical deviation encompassing a number of variants. The morphological difference occurs during budding of the hepatic diverticulum. We report the case of an asymptomatic pregnant woman who was incidentally found to have a large subhepatic cyst on ultrasound. The case highlights the difficulty in diagnosing large gallbladder duplication and the different radiological imaging available to surgeons to aid in mapping such anatomical variants. We propose that this case holds valuable lessons for both radiologists and surgeons when considering the differential diagnosis and management of large hepatobiliary cysts.

Prognostic indicators following curative pancreatoduodenectomy for pancreatic carcinoma: A retrospective multivariate analysis of a single centre experience.

PURPOSE: Survival after curative resection of pancreatic, ampullary and lower common bile duct cancer remains very poor. The aim of this study was to assess important prognostic factors in patients with resectable pancreatic cancer. METHODS: From 2006 to 2010, 156 patients underwent pancreatoduodenectomy (PD) for malignancies of pancreatic, ampullary or lower common bile duct in our institution. Based on the inclusion criteria 101 patients were selected in our retrospective statistical analysis. Of these 101 cases of malignancies, 65.4% were located in the pancreatic head, 18.8% in the ampulla and 15.8% in the lower bile duct. 48.5% of patients underwent classical PD, and 51.5% pylorus-preserving pancreatoduodenectomy (PPPD). Clinical and pathological data were collected, Kaplan-Meier method and Cox proportional hazard models were used to evaluate prognostic factors. RESULTS: Multivariate analysis revealed that blood transfusion, vascular invasion, T4 vs T1 stage, and R0 resection margins were significant negative predictors of survival. Conversely, ampullary (vs pancreatic ductal) and adjuvant chemotherapy were significantly associated with longer survival. Lymph node ratio (LNR), in all its forms, was not found to have a significant effect on survival. For all patients, tumor grading (p=0.042), resection margins (p=0.004), T stage (p=0.001), perineural invasion (p=0.029), vascular invasion (p=0.007) and age >65 years (p=0.009) were factors that impacted survival. CONCLUSION: Surgical resection margins, tumor grade, T stage, perineural invasion, vascular invasion, age >65 and adjuvant chemotherapy are the strongest predictors of survival after surgical resection of pancreatic, ampullary and lower common bile duct cancer. In this series, lymph node ratio did not impact survival.

Back to the gallstone: a mischievous cause of morbidity.

Laparoscopic cholecystectomies (LCs) are the gold standard treatment of symptomatic gallstone disease worldwide. However, with this technique comes the increased risk of retained spilled gallstones. We describe a case of a 77-year-old man who presented 2 months after undergoing a LC, with right upper quadrant pain. Abdominal ultrasound scan showed no significant complications, but he continued to have grumbling pains. These were investigated with an abdominal CT scan, prompting suspicion of a colorectal malignancy with pleural metastasis. However, on review by two different multidisciplinary teams, the final conclusion was probable residual gallstones with associated inflammation. This diagnosis was rather dramatically confirmed when the patient went on to expel gallstones percutaneously from his back and coughed out of his respiratory tract. This case highlights the importance of operative documentation of spilled gallstones, which can, in addition to more surprising consequences, mimic malignancy on investigation. This can lead to delay in correct management and cause undue patient distress.

Inflammatory fibroid polyp. A case report and review of the literature.

INTRODUCTION: The Inflammatory fibroid polyp (IFP) is a mesenchymal polypoid lesion of the gastrointestinal tract that follows a benign course. Incidence is extremely low: from 0,1% to 2 %. Histologically, it consists of a sub mucous proliferation of vascolarized fibromuscolar tissue with a high eosinophils inflammatory infiltration. IFP can arise everywhere in the gastrointestinal tract but is described more frequently in the gastric antrum (70%). CASE REPORT: We report a case of a 71-year-old woman presented to our department with a worsening history of lack's appetite, nausea and early satiety. We performed a review of the literature from 1949 to 2011. 196 cases of IFPs were found. CONCLUSION: Clinical symptoms are heterogeneous and endoscopy's examination revealed only presence of a sub-mucosal lesion, and their biopsies often gave not diagnostic localization. In the differential diagnosis, it's important to discern between eosinophilic gastroenteritis, gastrointestinal stromal tumor, inflammatory pseudotumor, hemangioendothelioma, and hemangiopericytoma. Eco-endoscopic appearance and biopsies associated may provide useful informations, that can steer to the diagnostic suspect of IFP. Despite this is a benign lesion, this one often needs a surgical excision on healthy margin. In literature is also described high local recurrence, specially when incomplete excision proceeded. KEYWORDS: Gastric sub-mucosal tumor, Inflammatory fibroid polyp, Stomach, Vanek's Tumor.

Use of intraoperative endoscopy to localize bleeding in the small intestine.

INTRODUCTION: Bleeding within the small intestine is difficult to diagnose and localize because it typically occurs at a slow rate. These patients may undergo multiple transfusions and repeated endoscopy, contrast studies, bleeding scans, and angiography before the bleeding source is identified. CASE REPORT: We report a case of 64-year-old woman, where both endoscopic and angiographic techniques were used to localize protracted bleeding. During endoscopic treatment, the arteriovenous malformations continued bleeding. However, highly selective angiography and intraoperative endoscopy outlined the segments of small intestine for resection. This case reviews the evaluation, localization and treatment of small intestine bleeding. DISCUSSION: Localizing the site of protracted bleeding in the small intestine beyond the duodenum bulb can be problematic. For some patients, the course of examinations and transfusions can take years. The small intestine is an uncommon site for gastrointestinal hemorrhage, and only 3%-5% of gastrointestinal bleeding occurs between the ligament of Treitz and the ileocecal valve. The length and location of the small intestine, along with other anatomical factors, make this area difficult to assess with endoscopy or radiology. In this case of protracted bleeding, highly selective angiography and intraoperative endoscopy were used to locate the source of the bleeding.

Solitary skin metastasis from sarcomatoid carcinoma of the bladder: a case report.

INTRODUCTION: Cutaneous metastases from carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. The common treatment modality of cutaneous metastases from a primary bladder cancer is wide local excision followed by chemotherapy. CASE PRESENTATION: We report a case of solitary skin metastasis from a rare type of urinary bladder carcinoma in a 68 year-old Caucasian man. Urinary bladder carcinoma metastasizing to the skin is an uncommon finding despite the high incidence of this tumor. Skin metastasis generally presents in the late stages of this disease and indicates a poor outcome. CONCLUSIONS: Because of the extremely aggressive malignant potential of sarcomatoid carcinomas, the indications for a transurethral resection of the bladder should be carefully assessed and suitable therapeutic strategies should be examined further.

[Bodypackers syndrome. A case report and review of the literature]. / La sindrome "body packers". Caso clinico e revisione della letteratura.

INTRODUCTION: With the term Body packers we identify people who carry drugs hidden in their bodies especially on international flights. These event are constantly increasing all over the world. The accidental spontaneous opening of the drug packers is the major risk for patient's life, because the release cocaine inside the bowel can stir up the Body packers Syndrome. This eventuality is a medical surgical emergency that needs a wel timed diagnosis and a sudden treatment. CASE REPORT: We report a case of a 31 years old Caucasian woman, admitted from Rome International Airport to the nearest Emergency Unit and then moved to our Department because of suspected epilepsy hiding a diagnosis of Body packers Syndrome in acute phase. When the diagnosis was made, the woman was submitted to a colonoscopy and ciecotomy, and fifty-three packets were removed. In intensive care any complication occurred after surgery. CONCLUSION: The Body packing of drugs it's constantly a going problem. In Italy currently there aren't shared guide lines about the management of these patients. The international experience reports that in asymptomatic patients is enough a conservative treatment to help the spontaneous evacuation of packets but if the Body packers Syndrome is already present the best treatment is the surgical one. Quickness, accuracy and right use of radiology are the main factors to reach a correct diagnosis and to obtain a good result.

A Malignant Gastrointestinal Stromal Tumor of the Gallbladder Immunoreactive for PDGFRA and Negative for CD 117 Antigen (c-KIT).

Gastrointestinal stromal tumors (GISTs) compose the largest category of well-recognized nonepithelial neoplasms of the gastrointestinal tract (GI). GISTs of the gallbladder are extremely rare tumors. Only four malignant, two benign and one GIST-like tumor of the gall bladder have ever been described. The four malignant GISTs were all positive for CD 117 antigen (c-kit). We present for the first time a malignant gastrointestinal stromal tumor of the gallbladder, immunoreactive for platelet-derived growth factor receptor alpha (PDGFRA) and negative for CD 117 antigen (c-KIT).

Groove pancreatitis. A mini-series report and review of the literature.

CONTEXT: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.