Publication:

Groove pancreatitis presenting as gastric outlet obstruction with phytobezoar: a diagnostic challenge

A 61-year-old man presented with three months of persistent vomiting of undigested food, marked weight loss, and melena, with a history of long-standing dyspepsia. Initial imaging demonstrated a mass at the gastroduodenal junction, raising concern for malignancy, but further evaluation revealed features consistent with groove pancreatitis, including duodenal wall thickening, pancreatoduodenal groove changes, and a bulky pancreatic head. Endoscopy identified a large gastric phytobezoar complicating gastric outlet obstruction, which was removed endoscopically. Conservative management with pancreatic enzyme replacement, nutritional supplementation, and proton pump inhibitor therapy led to clinical improvement. This case underscores the diagnostic difficulty in differentiating groove pancreatitis from malignancy and highlights the value of non-surgical management in selected patients.