ABSTRACT
Ectopic pancreas within the mesentery is rare. In this case report, a 61-year-old man with an ectopic pancreas within the jejunal mesentery for over 20 years developed chronic pancreatitis that progressed to acute exacerbation. Our computed tomography (CT) performed for acute abdomen assessment suggested acute appendicitis or Meckel's diverticulitis. However, a CT scan taken 20 years ago revealed a structure indicative of an ectopic pancreas in the mesentery, and further imaging findings taken 10 and 4 years ago confirmed progression to chronic pancreatitis. Furthermore, we found a pancreatic stone confined in the luminal structure that corresponded to the main pancreatic duct; this stone eventually caused acute exacerbation. In summary, we report a case of mesenteric ectopic pancreas that showed typical findings of progression and acute exacerbation of chronic pancreatitis on CT.
ABSTRACT
Ectopic pancreas, also known as heterotopic pancreas, is a rare condition in which the pancreatic tissue is found outside its usual location in the gastrointestinal (GI) tract. It is commonly asymptomatic and benign, and is often discovered incidentally during routine imaging, endoscopy, surgery, or autopsy. However, complications can arise, such as inflammation, bleeding, obstruction, or even malignant transformation, necessitating surgical intervention in some cases. Ectopic pancreas at the ampulla of Vater (EPAV) is an extremely rare condition and a diagnostic and therapeutic nightmare. Most cases have been diagnosed through invasive surgery due to concerns for malignancy, which carries significant morbidity and mortality. In our case, endoscopic snare papillectomy (ESP) was employed to establish a diagnosis. Thus far, only one other case has been reported in which ESP was used to diagnose and resect a pancreatic heterotopia at the ampulla.
Subject(s)
Ampulla of Vater , Choristoma , Pancreas , Humans , Ampulla of Vater/surgery , Choristoma/surgery , Choristoma/diagnosis , Choristoma/pathology , Female , Male , Middle Aged , Cholangiopancreatography, Endoscopic RetrogradeABSTRACT
Heterotopic pancreas (HP) is the presence of pancreatic tissue outside of its normal anatomical position without vascular continuity from the main pancreas. HP is most commonly found within the gastrointestinal tract, particularly the stomach through the jejunum. This report shares the case of a 57-year-old man who presented with persistent vomiting despite medical therapy. Given the nonspecific and broad differential diagnosis, a histopathological examination was warranted for a definitive diagnosis that showed a uniquely large and well-differentiated type I HP in the lesser curvature of the stomach. Resection was completed which was followed with resolution of symptoms.
ABSTRACT
Ectopic pancreas (EP) is an uncommon, congenital focus of pancreatic tissue that is discontinuous with the principal pancreas. A 62-year-old female underwent multiple investigations for chronic epigastric pain. EP was identified intra-operatively. On retrospection, earlier imaging showed a thickened segment of jejunum with inflammation of the surrounding small bowel mesentery, suggestive of jejunal EP pancreatitis. Histology confirmed ectopic pancreatic tissue, with sections of the EP showing evidence of previous acute and chronic pancreatitis. When no cause for chronic abdominal pain is found, diagnostic laparoscopy should be considered, and the small bowel inspected, to further investigate for rare causes of abdominal pain, such as EP.
ABSTRACT
Background: Ectopic pancreas (EP), characterized by pancreatic tissue outside its usual location, poses diagnostic challenges due to its asymptomatic nature in most cases. Gastric lesions are often symptomatic, causing epigastric pain or gastric outlet obstruction. Rarely, jejunal lesions can lead to intestinal obstruction or intussusception. The elusive preoperative diagnosis lacks specific biochemical markers, relying on intraoperative biopsy and histopathology as gold standards. Case Presentation: We present a unique case of a 37-year-old female with 12-hour crampy abdominal pain, bilious vomiting, blood-mixed diarrhea, abdominal distension, and obstructive symptoms. Imaging revealed jejunojejunal intussusception with a jejunal mass as the lead point. Intraoperatively, also identified jejunal mass as lead point. Resection of mass and end-to-end jejunojejunal anastomosis were performed, resulting in a successful outcome. Histopathological examination identified a type I ectopic pancreas within the muscularis propria. Twelve months postoperatively, the patient exhibited no stricture or recurrence. Conclusion: Ectopic pancreas, with varied symptoms, poses diagnostic hurdles. Despite the diagnostic challenges, surgical excision remains the optimal treatment for symptomatic cases. This report contributes to the limited literature on ectopic pancreas, emphasizing the importance of considering this entity in the differential diagnosis of gastrointestinal pathology.
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Heterotopic pancreas is a relatively rare condition that may be associated to clinical complaints or signs. Here, we report a case of gastric heterotopic pancreas assictaed to ductal adenocarcinoma. Obstructive jaundice was the initial symptom prompting medical intervention. A 73-year-old male patient presented with yellow staining of the skin and sclera, and dull epigastric pain. Contrast-enhanced computed tomography showed stenosis of the extrahepatic distal bile duct and mass lesions of the antrum. The patient underwent tumor resection, distal gastrectomy (Billroth II), and common bile duct exploration. Postoperative pathological examination revealed an adenocarcinoma located in the wall of the gastric antrum. Immunohistochemical results suggested that the tumor originated from the pancreas. Heterologous pancreatic tissue and a dilated pancreatic duct were found in the tumor. These findings suggest malignant transformation of the gastric heterotopic pancreas. Of note, jaundice as clinical complaint for adenocarcinoma associated to gastric heterotopic pancreas.
ABSTRACT
Heterotopic pancreas (HP) also known as ectopic pancreas, pancreatic crest or accessory pancreas is the normal pancreatic tissue, found in a remote area other than its natural location, with no anatomic or vascular connection to main pancreatic tissue. It is a rare congenital anomaly and has been reported at many locations such as stomach (antrum) and small intestine. HP is usually an incidental finding and asymptomatic, however there are reports of pancreatitis, obstruction, perforation and malignant transformation as uncommon manifestations. Diagnosis of HP is primarily based on histological examination either by biopsy or surgical excision. Surgery is the standard treatment for symptomatic HP patients. Herein, we present a case of a 58-year-old female, who presented to us with intractable diarrhoea due to HP in the jejunum and underwent minimally invasive surgery for definitive diagnosis and treatment.
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OBJECTIVE: Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients. METHODS: We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed. RESULTS: The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel's diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel's diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient's age, the lesion site and size, and coexisting diseases. CONCLUSIONS: Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel's diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options.
Subject(s)
Choristoma , Pancreas , Humans , Retrospective Studies , Choristoma/surgery , Choristoma/diagnosis , Male , Female , Pancreas/surgery , Child , Child, Preschool , Infant , Adolescent , Meckel Diverticulum/surgery , Meckel Diverticulum/diagnosisABSTRACT
The occurrence of ectopic pancreas in the mediastinum is rare. Herein, we report a 22-year-old female who presented with right shoulder pain, dysphagia, fever and headaches. Chest computer tomography revealed a mass in the posterior mediastinum with accompanying signs of acute mediastinitis. Needle biopsy and fine-needle aspiration revealed ectopic gastral tissue and ectopic pancreas tissue, respectively. Surgical resection was attempted due to recurring acute pancreatitis episodes. However, due to chronic-inflammatory adhesions of the mass to the tracheal wall, en-bloc resection was not possible without major tracheal resection. Since then, recurring pancreatitis episodes have been treated conservatively with antibiotics. We report this case due to its differing clinical and radiological findings in comparison to previous case reports, none of which pertained a case of ectopic pancreas tissue in the posterior mediastinum with recurring acute pancreatitis and mediastinitis.
Subject(s)
Choristoma , Mediastinitis , Pancreatitis , Female , Humans , Young Adult , Acute Disease , Choristoma/surgery , Choristoma/diagnosis , Mediastinitis/diagnosis , Mediastinitis/surgery , Mediastinitis/complications , Mediastinum/diagnostic imaging , Mediastinum/pathology , Pancreas/pathology , Pancreatitis/complications , Pancreatitis/diagnosisABSTRACT
INTRODUCTION AND IMPORTANCE: Obesity is a global epidemic, and bariatric surgery is an effective treatment. During this surgery, rare abnormalities in the small intestine, like ectopic pancreas (EP), can be found. CASE PRESENTATION: A 16-year-old male presented at the surgical clinic with a complaint of morbid obesity, weighing 140 KG. Since he was unable to commit to a diet, bariatric surgery was performed. During the surgery, the gastrointestinal tract was examined, and an incidental finding was noted in the wall of the proximal jejunum. The histopathology report revealed that the excisional biopsy was a complete EP in the proximal jejunum. The patient was discharged from the hospital on the first postoperative day, and his condition remained stable. CLINICAL DISCUSSION: Our case of EP stood out due to its larger size, measuring 3.5 cm in diameter, while EP lesions are typically smaller, despite its size, the patient did not experience any symptoms. EP is more commonly found in individuals between 40 and 50 years old, with a higher incidence in males. However, our patient is only 16 years old. CONCLUSION: Surgical resection is the most effective treatment, preventing malignant transformation and future complications. To the best of our knowledge, this is the first documented case of incidentally detected heterotopic pancreatic tissue in jejunum during a bariatric procedure in Syria, and it is also the fourth case in the medical literature.
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CASE PRESENTATION: A 61-year-old female was referred to our hospital with a neoplastic lesion in the duodenum. Computed tomography with contrast enhancement revealed a 10-mm tumor in the duodenum. Upper gastrointestinal endoscopy revealed a submucosal tumor-like lesion in the descending part of the duodenum. Endoscopic ultrasound revealed a well-defined hypoechoic tumor. Biopsy and immunohistochemical findings including negative Synaptophysin and Chromogranin A staining and positive Trypsin and BCL10 staining suggested a carcinoma with acinar cell differentiation. Pancreatoduodenectomy was performed, and the resected specimen had a 15-mm solid nodule in the submucosal layer of the duodenum. Pancreatogram of the resected specimen revealed a tumor localized in the accessory papilla region. In histopathological examination, the tumor was found in the submucosa of the duodenum with pancreatic tissue present nearby, and these were separated from the pancreatic parenchyma by the duodenal muscle layer. These findings led to a diagnosis of acinar cell carcinoma originating from the accessory papilla of the duodenum. CONCLUSION: Acinar cell carcinoma originating from the accessory papilla of the duodenum is exceptionally rare, with no reported cases to date. The origin was considered to be pancreatic tissue located in the accessory papilla region.
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Introduction and importance: Ectopic pancreas is not uncommon, but ileocecal intussusception caused by ectopic pancreas is extremely rare. Thus far, only approximately 10 cases have been reported. Case presentation: Herein, we report a 47-year-old male who presented with abdominal distension and discomfort without apparent cause, accompanied by nausea but no vomiting or other symptoms. The patient's vital signs were stable, and examination revealed increased bowel sounds, tympanic percussion of the abdomen, and tenderness in the lower right abdomen. After laparoscopic exploration, an irreducible intestinal obstruction was found, which subsequently required open surgery. Pathological examination of the resected portion revealed that the patient's ileocecal intussusception was caused by ectopic pancreas. Clinical discussion: Prior to receiving the pathological report, we were not aware that the patient's abdominal pain may have been attributed to ileocecal intussusception induced by ectopic pancreas. This posed challenges in diagnosis and treatment, underscoring the importance of raising awareness among our colleagues through this case report. Conclusion: Our findings emphasize the need to consider the possibility of abdominal pain caused by ileocecal intussusception induced by ectopic pancreas during the investigation of abdominal pain.
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This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery. Our primary focus is on the causes, location, diagnosis, histological classification, and therapy of ectopic pancreas. Ectopic pancreas refers to the presence of pancreatic tissue that is situated in a location outside its usual anatomical placement, and is not connected to the normal pancreas in terms of blood supply or anatomical structure. Currently, the embryological origin of ectopic pancreas remains uncertain. The most prevalent form of ectopic pancreatic is gastric ectopic pancreas. Endoscopic ultrasonography examination can visualize the morphological characteristics of the ectopic pancreatic lesion and pinpoint its anatomical location. The histological categorization of ectopic pancreas evolves. Endoscopic treatment has been widely advocated in ectopic pancreas.
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A Meckel's diverticulum (MD) is an embryonic remnant of the omphalomesenteric duct. Although most MDs are usually asymptomatic, pediatric patients tend to present serious complications more frequently (4-25% of cases), mainly in digestive tract bleeding, intestinal obstruction, and perforation, which have a high potential to compromise the patient's life. An ectopic pancreas (EP) is pancreatic tissue found outside the pancreas, usually in the stomach, duodenum, and jejunum. It is typically asymptomatic but can increase the risk of complications in the MD. A clinical case of a female infant with an MD complicated with bleeding and ileo-ileal intussusception is presented, in which the histopathological finding of type 1 ectopic pancreatic tissue was also found based on the Heinrich classification, being an entity uncommon in our environment. An EP arising within an MD is infrequent, requiring clinical attention and timely preoperative diagnosis to prevent and treat associated severe complications. This continues to be a superior challenge for the clinician and requires a multidisciplinary team for comprehensive treatment.
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Ectopic pancreas refers to pancreatic tissue that lacks vascular or anatomical connection with the main body of the pancreas. Superior mesenteric artery syndrome involves the compression of the third part of the duodenum between the aorta and the superior mesenteric artery. We present a case of a 12-year-old female with a 4-year history of recurrent episodes of severe epigastric pain, improved by sitting and leaning forward, and occurred monthly for nearly 48 h. Radiological findings confirmed the diagnosis of superior mesenteric artery syndrome. However, further investigation revealed the presence of ectopic pancreas. Surgical intervention successfully treated both conditions. The patient presented with severe abdominal pain, and although there was a diagnosis of superior mesenteric artery syndrome, the pain was not entirely attributable to this condition, as there was no correlation with food intake, and the degree of obstruction was mild. Further investigations revealed the presence of ectopic pancreas, which provided an explanation for the severity of the pain. This case highlights the need for further research on the potential association between superior mesenteric artery syndrome and ectopic pancreas.
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A 25-year-old man was referred to our center for investigation of a gastric submucosal tumor and an ulcer that had developed on its oral side. Endoscopic ultrasonography findings suggested the presence of an ectopic pancreas, and treatment with an oral proton pump inhibitor was planned for the ulcer. Over the subsequent 3 years, the patient endured recurring epigastric pain and episodes of passing black stools. Emergency endoscopy revealed that the morphology of the gastric submucosal tumor had transformed into a pedunculated polyp-like morphology with a bleeding ulcer at the apex of the lesion. Endoscopic hemostasis using hemostatic forceps was performed. However, the patient continued to pass black stools. In light of the persistent symptoms and unique morphology of the lesion, endoscopic resection was attempted as a curative approach. The lesion was excised by hot snare polypectomy. Post-treatment, the patient exhibited no signs of recurrence, marking a successful resolution. Three months later, a gastroduodenal endoscopy showed that the excised site had undergone scar formation without recurrence of the lesion. This case holds significant clinical value as it demonstrates the efficacy of a minimally invasive treatment strategy in managing repeated bleeding ulcerations of an ectopic pancreas, ultimately achieving a complete cure.
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The incidence of malignant transformation in ectopic pancreas (EP), including adenocarcinoma, is extremely rare. Herein, we presented a single case with invasive adenocarcinoma caused by the EP in the stomach. The patient consulted our hospital due to abdominal discomfort with acid regurgitation. Computed tomography scan showed a pyloric obstruction and thickening of the gastric wall in the gastric antrum; a digestive endoscopic examination showed mucosal congestion, swelling in the anterior pyloric area, and pyloric canal stenosis. Next, the patient underwent gastrointestinal surgery, and the distal gastrectomy specimens revealed a deviation of 10 cm towards the lesser curvature and an extension of 22 cm towards the greater curvature. A 5.5 x 5.4 cm round-like mass was found during surgery. Pathological examination suggested invasive submucosal adenocarcinoma located under the gastric antrum mucosa. Our report provides additional clinical experience for diagnosing EP with canceration in the stomach.
Subject(s)
Adenocarcinoma , Stomach Neoplasms , Humans , Stomach Neoplasms/diagnostic imaging , Stomach Neoplasms/surgery , Pyloric Antrum/pathology , Pancreas/diagnostic imaging , Pancreas/pathology , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/surgeryABSTRACT
BACKGROUND: Ectopic pancreas may be unfamiliar to many people because it is rare and difficult to diagnose. However, this disease is highly susceptible to misdiagnosis and missed diagnosis. In this article, we report two cases of pancreatic heterotopia in the gastric sinus and small intestine, respectively, both of which were confirmed by histopathological examination. CASE SUMMARY: The first patient was a 43-year-old female which reported abdominal distension for 2 mo. The second was a 67-year-old female who experienced intermittent epigastric discomfort for 15 d. In both cases, there was no confirmed preoperative examination, and the postoperative pathology indicated the presence of ectopic pancreas. CONCLUSION: The diagnosis of ectopic pancreas is difficult, and is often prone to misdiagnosis and the possibility of being overlooked. Various laboratory tests and imaging tests should be carefully evaluated before surgery to achieve early detection, early diagnosis and early treatment.
ABSTRACT
Ectopic pancreatic tissue is a rare congenital abnormality defined as the abnormal location of pancreatic tissue outside the anatomical site of the pancreas without any anatomical or vascular connection to it, which is often discovered incidentally. This is a case of a 40-year-old man who was admitted to our surgical department for emergency cholecystectomy due to acute gangrenous cholecystitis. Preoperative ultrasound imaging was indicative only of multiple stones in the gallbladder. Postoperative histopathological examination revealed an area of wall thickening in the neck region of the gallbladder consists of ectopic pancreatic tissue. We emphasize the role of a precise pathologic examination even in routine surgical specimens such as a cholecystectomy specimen, since no preoperative evaluation can be affirmative of such incidental but momentous histopathologic findings. Anatomical pathologists must be aware of the rare presentation of Ectopic Pancreatic Tissue (EPT) in gallbladder which may masquerade as a malignancy.