S3221 Groove Pancreatitis in a Young Female Without Alcohol Use: An Uncommon Presentation

Introduction: Groove pancreatitis (GP) is a rare subtype of chronic pancreatitis affecting the anatomical “groove” between the pancreatic head, duodenum, and common bile duct. Most frequently observed in middle-aged men with chronic alcohol use and smoking history, it mimics pancreatic malignancy in both clinical and radiologic presentations. We report a unique case with minimal alcohol history and no prior biliary pathology, emphasizing the diagnostic challenge and need for awareness of atypical presentations. Case Description/Methods: A 43-year-old woman presented with 5 days of sharp epigastric pain radiating to the back, accompanied by nausea, chills, and poor appetite. She denied vomiting, diarrhea, fever, or GI bleeding. She had no history of smoking, alcohol or drug use, gallstones, autoimmune disease, or recent medication changes. Exam showed diffuse abdominal tenderness without peritoneal signs. Labs revealed an elevated lipase (222 U/L), with normal liver enzymes, WBC, lipids, and IgG4. Computed tomography abdomen showed small cystic lesions in the pancreaticoduodenal groove, consistent with groove pancreatitis (GP). Esophagogastroduodenoscopy revealed duodenal edema and gastritis. She continues with gastroenterology follow up. Discussion: GP remains a diagnostic challenge due to its mimicry of pancreatic cancer and its rarity, particularly in young females without classic risk factors. Literature cites most cases in middle-aged males with significant alcohol history. Our patient represents an atypical demographic without alcohol or tobacco use, normal imaging on prior visits, and no autoimmune or ductal abnormalities. Conservative therapy remains the mainstay for most patients and includes bowel rest, analgesia, PPI therapy, and nutritional support. Surgery is reserved for persistent or obstructive symptoms or when malignancy cannot be excluded. This case highlights the importance of including GP in the differential for recurrent pancreatitis-like symptoms, even in young, low-risk female patients.