MODERN VIEW ON DIAGNOSTICS AND TREATMENT OF DUODENAL DYSTROPHY COMPLICATED BY CHRONIC PANCREATITIS (LITERATURE REVIEW)

Duodenal dystrophy is a rare surgical pathology caused by presence of heterotopic pancreatic tissue in duodenal wall. The presence of heterotopic tissue may remain long-term asymptomatic. But due to provoking pancreatic tissue inflammation factors duodenal dystrophy evolves. Thereby the patients with duodenal dystrophy are mostly employable smoking and drinking alcohol men. In the literature researches are also used other names of this nosological form. The most common are paraduodenal pancreatitis and groove pancreatitis. Pathophysiology of the disease is also controversial, but two factors of development are clearly visible, such as the presence of heterotopic pancreatic tissue in duodenal wall and patient alcohol consumption. The clinical features of duodenal dystrophy are non-specific. The most common symptoms are pain in epigastrium and abdominal discomfort, postprandial nausea and vomiting, weight loss. Instrumental diagnostics reveal a thickened wall of the duodenum with the presence of cysts in it. The most sensitive and specific diagnostic methods are computed tomography, magnetic resonance imaging and endoscopic ultrasonography. Conservative treatment with synthetic somatostatin analogues is preferred as first-line therapy. The most commonly used endoscopic treatment is endoscopic drainage of the duodenal cysts, which may be associated with drug therapy. Surgical treatment methods are used primarily in cases of complicated duodenal dystrophy, the impossibility of excluding the oncological process of the affected area, and also when conservative and endoscopic methods are ineffective. Pancreaticoduodenectomy is the most preferred surgical treatment worldwide, but there has been increasing debate about its excessiveness.

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