Suspected Groove Pancreatitis Complicated by Anastomotic Stricture and Recurrent Intrahepatic Lithiasis: A Case Report

Abstract

Groove pancreatitis is a rare form of chronic pancreatitis involving the pancreatoduodenal groove and may mimic pancreatic or periampullary malignancy, creating substantial diagnostic uncertainty. We report a 67-year-old man with a history of alcohol use, a 10-pack-year smoking history, chronic pancreatitis, and suspected groove pancreatitis who underwent biliodigestive diversion, cholecystectomy, and pancreatic biopsy in 2017; malignancy was ultimately excluded. Several years later, he developed recurrent cholangitis associated with a biliary-enteric anastomotic stricture and progressive intrahepatic lithiasis. Imaging demonstrated persistent left intrahepatic ductal dilatation and anastomotic narrowing. Management consisted of percutaneous transhepatic biliary drainage, repeated drain exchanges, and serial cholangioplasties, with partial reduction of stone burden despite persistent stricture. This case illustrates the challenges of long-term management of late biliary complications after pancreatobiliary surgery and the potential role of serial minimally invasive interventions in maintaining biliary drainage and deferring surgical reintervention.