Case 248: Cystic Duodenal Dystrophy with Groove Pancreatitis.

History A 59-year-old man presented to the gastroenterology outpatient department with acute abdominal pain centered in the epigastrium. He had experienced similar episodes of abdominal pain in the past that had been treated with surgery. He reported multiple failed attempts at upper gastrointestinal endoscopy. Laboratory tests were performed at the time of admission and revealed a serum glutamic-oxaloacetic transaminase level of 9 U/L [0.15 μkat/L] (normal range, 5-40 U/L [0.08-0.67 μkat/L]), a serum glutamic-pyruvic transaminase level of 34 U/L [0.57 μkat/L] (normal range, 5-45 U/L [0.08-0.75 μkat/L]), a serum γ-glutamyltransferase level of 210 U/L (3.50 μkat/L) (normal range, 10-50 U/L [0.17-0.83 μkat/L]), a serum alkaline phosphatase level of 157 U/L (2.62 μkat/L) (normal range, 30-120 U/L [0.50-2.0 μkat/L]), a serum amylase level of 210 U/L (3.50 μkat/L) (normal range, 30-100 U/L [0.50-1.66 μkat/L]), a serum lipase level of 391 U/L (6.52 μkat/L) (normal range, 13-60 U/L [0.21-1.0 μkat/L]), an α-fetoprotein level of 3.81 ng/ mL (normal range, 0-9 ng/mL), a total protein level of 4.6 g/dL (normal range, 6.0-8.5 g/dL), and an albumin level of 2.6 g/dL (normal range, 3.5-5.2 g/dL). The rest of the laboratory data were unremarkable. The patient underwent erect abdominal radiography, contrast material-enhanced multidetector row computed tomography (CT) of the abdomen with 100 mL of iohexol (300 mg iodine per milliliter, Omnipaque; GE Healthcare, Shanghai, China) followed by combined positron emission tomography (PET) and CT (hereafter, PET/CT) with 6.9 mCi of fluorodeoxyglucose (FDG) and magnetic resonance (MR) imaging of the upper abdomen.