1
|
Yang X, Liu C, Sun S, Dong C, Zhao S, Bokhary ZM, Liu N, Wu J, Ding G, Zhang S, Geng L, Liu H, Fu T, Gao X, Niu Q. Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study. Pediatr Surg Int 2024; 40:141. [PMID: 38811418 PMCID: PMC11136705 DOI: 10.1007/s00383-024-05722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
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.
Collapse
Affiliation(s)
- Xiaofeng Yang
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chen Liu
- Department of Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuai Sun
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chao Dong
- Department of General Surgery, Zibo Hospital of Shandong Yiyang Health Industry Development Group Co, Ltd, Zibo, China
| | - Shanshan Zhao
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zaitun M Bokhary
- Department of Pediatric Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Na Liu
- Department of Pathology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Jinghua Wu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Guojian Ding
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Shisong Zhang
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China.
| | - Hongzhen Liu
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China.
| | - Xiangqian Gao
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, China.
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China.
| |
Collapse
|
2
|
Farho MA, Alrawi M, Mobaid M, Kudsi MA, Hendi H, Ghazal A. Ectopic pancreas in a 16-year-old male during bariatric surgery: A rare case in the medical literature. Int J Surg Case Rep 2024; 118:109613. [PMID: 38608520 PMCID: PMC11024645 DOI: 10.1016/j.ijscr.2024.109613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Mohamad Ali Farho
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Mawya Alrawi
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic.
| | - Maram Mobaid
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | | | - Hamza Hendi
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ahmad Ghazal
- Department of General Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic
| |
Collapse
|
3
|
Amseian G, Ayuso JR. Pancreatic congenital anomalies and their features on CT and MR imaging: a pictorial review. Abdom Radiol (NY) 2024; 49:1734-1746. [PMID: 38478039 DOI: 10.1007/s00261-024-04229-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To review the congenital anomalies of the pancreas with their main clinical manifestations and key imaging findings on CT and MRI. BACKGROUND AND CLINICAL SIGNIFICANCE Anomalies of pancreatic development are frequent and generally asymptomatic, but can mimic and predispose individuals to pancreatic or peripancreatic pathologies, such as pancreatitis or malignancy. Their correct diagnosis may help avoid unnecessary further investigations and procedures, or establish adequate treatment when they manifest clinically. Differentiating pancreatic congenital anomalies from their main radiological mimics constitutes a challenge for the radiologist and requires familiarity with key imaging findings. CONCLUSION The imaging findings of CT and MRI are essential for the correct diagnosis of congenital pancreatic anomalies.
Collapse
Affiliation(s)
- Gary Amseian
- Department of Radiology, Barcelona Hospital Clínic, Barcelona, Spain.
| | - Juan-Ramón Ayuso
- Department of Radiology, Barcelona Hospital Clínic, Barcelona, Spain
| |
Collapse
|
4
|
Brun-Vergara ML, Khoshpouri P, Karp J, Sailer A, Pickhardt PJ. Heterotopic Pancreatitis. Radiographics 2024; 44:e230167. [PMID: 38096108 DOI: 10.1148/rg.230167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Maria L Brun-Vergara
- From the Department of Radiology, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9 (M.L.B.V.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (J.K.); Department of Radiology, Yale New Haven Health, Yale University, New Haven, Conn (A.S.); and Department of Radiology, University of Wisconsin, Madison, Wis (P.J.P.)
| | - Pegah Khoshpouri
- From the Department of Radiology, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9 (M.L.B.V.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (J.K.); Department of Radiology, Yale New Haven Health, Yale University, New Haven, Conn (A.S.); and Department of Radiology, University of Wisconsin, Madison, Wis (P.J.P.)
| | - John Karp
- From the Department of Radiology, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9 (M.L.B.V.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (J.K.); Department of Radiology, Yale New Haven Health, Yale University, New Haven, Conn (A.S.); and Department of Radiology, University of Wisconsin, Madison, Wis (P.J.P.)
| | - Anne Sailer
- From the Department of Radiology, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9 (M.L.B.V.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (J.K.); Department of Radiology, Yale New Haven Health, Yale University, New Haven, Conn (A.S.); and Department of Radiology, University of Wisconsin, Madison, Wis (P.J.P.)
| | - Perry J Pickhardt
- From the Department of Radiology, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9 (M.L.B.V.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (J.K.); Department of Radiology, Yale New Haven Health, Yale University, New Haven, Conn (A.S.); and Department of Radiology, University of Wisconsin, Madison, Wis (P.J.P.)
| |
Collapse
|
5
|
Guerrero-Pérez F, Vilarrasa N, Huánuco LV, Busquets J, Secanella L, Vercher-Conejero JL, Vidal N, Näf Cortés S, Villabona C. Ectopic insulinoma: a systematic review. Rev Endocr Metab Disord 2023; 24:1135-1146. [PMID: 37434098 DOI: 10.1007/s11154-023-09824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/13/2023]
Abstract
Knowledge of ectopic insulinomas comes from single cases. We performed a systematic review through PubMed, Web of Science, Embase, eLibrary and ScienceDirect of all cases reported in the last four decades. We also describe one unreported patient. From 28 patients with ectopic insulinoma, 78.6% were female and mean age was 55.7 ± 19.2 years. Hypoglycaemia was the first symptom in 85.7% while 14.3% complained of abdominal pain or genital symptoms. Median tumour diameter was 27.5 [15-52.5] mm and it was localised by CT (73.1%), MRI (88.9%), [68Ga]Ga-DOTA-exedin-4 PET/CT (100%), 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC (100%), somatostatin receptor scintigraphy (40%) and endoscopic ultrasound (50%). Ectopic insulinomas were located at duodenum (n = 3), jejunum (n = 2), and one respectively at stomach, liver, appendix, rectum, mesentery, ligament of Treitz, gastrosplenic ligament, hepatoduodenal ligament and splenic hilum. Seven insulinomas were affecting the female reproductive organs: ovary (n = 5), cervix (n = 2) and remaining tumours were at retroperitoneum (n = 3), kidney (n = 2), spleen (n = 1) and pelvis (n = 1). 89.3% underwent surgery (66.7% surgery vs. 33.3% laparoscopy) and 16% underwent an ineffective pancreatectomy. 85.7% had localized disease at diagnosis and 14.3% developed distant metastasis. Median follow-up time was 14.5 [4.5-35.5] months and mortality was reported in 28.6% with median time until death of 60 [5-144] months. In conclusion, ectopic insulinomas are presented as hypoglycaemia with female preponderance. Functional imaging [68Ga]Ga-DOTA-exedin-4 PET/CT and 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC have very high sensitivity. Clinicians should be alert to the possibility of extra-pancreatic insulinomas when classic diagnostic tests and intraoperative pancreas exploration failed to locate the tumour.
Collapse
Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Bellvitge University Hospital, Barcelona, Spain.
- Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Nuria Vilarrasa
- Department of Endocrinology, Bellvitge University Hospital, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia V Huánuco
- Department of Endocrinology, Bellvitge University Hospital, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juli Busquets
- Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lluis Secanella
- Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José L Vercher-Conejero
- Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nuclear Medicine-PET Unit, University Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Noemi Vidal
- Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Pathology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia Näf Cortés
- Department of Endocrinology, Joan XXIII University Hospital, Tarragona, Spain
| | - Carles Villabona
- Department of Endocrinology, Bellvitge University Hospital, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
6
|
Yoshikawa C, Migita K, Yamato I, Ueno M, Kashizuka H, Murakami K, Ishikawa H. Acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, in an adult with intestinal malrotation: a case report. Surg Case Rep 2023; 9:150. [PMID: 37638994 PMCID: PMC10462583 DOI: 10.1186/s40792-023-01736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Intestinal duplication and ectopic pancreas are two rare independent congenital anomalies. Few reports describe cases of patients with ectopic pancreas in an intestinal duplication causing acute peritonitis. CASE PRESENTATION A 31-year-old man was admitted to the hospital for epigastric pain. The patient was diagnosed with acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, with intestinal malrotation. The patient underwent the partial resection of the jejunum and Ladd's procedure. The histopathological findings indicated ectopic pancreatitis in the jejunal duplication. CONCLUSIONS We presented the case of acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication in an adult with intestinal malrotation. Surgery is the primary treatment and is necessary for a definitive diagnosis.
Collapse
Affiliation(s)
- Chihiro Yoshikawa
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan.
| | - Kazuhiro Migita
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Ichiro Yamato
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Masato Ueno
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Hisanori Kashizuka
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Koichi Murakami
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Hirofumi Ishikawa
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| |
Collapse
|
7
|
Yang CW, Che F, Liu XJ, Yin Y, Zhang B, Song B. Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. Insights Imaging 2021; 12:144. [PMID: 34674040 PMCID: PMC8531187 DOI: 10.1186/s13244-021-01089-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
Heterotopic pancreas (HP) is an uncommon congenital abnormality in the developmental process of the pancreas, with gastrointestinal heterotopic pancreas (GHP) being the most common HP. The clinical manifestations of GHP may have variable patterns of presentation, dictated by both the anatomic location and the functional ability of the lesion. The most common imaging modality in detecting GHP is computed tomography (CT), while gastrointestinal barium fluoroscopy, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are also applied. The density and enhancement patterns of GHP are consistent with histological classifications. GHP with a predominantly acinar tissue component manifests homogeneous and marked enhancement on CT images, whereas a predominantly ductal GHP presents heterogeneous and mild enhancement. On MRI, the appearance and signal intensity of GHP were paralleled to the normal pancreas on all sequences and were characterized by T1-weighted high signal and early marked enhancement. This article provides a comprehensive review of the histopathology, clinical manifestations, imaging features of various modalities, and differential diagnosis of GHP. It is hoped that this review will improve clinicians' knowledge of GHP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate.
Collapse
Affiliation(s)
- Cai-Wei Yang
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Feng Che
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| |
Collapse
|
8
|
Diagnosis, natural course and treatment outcomes of groove pancreatitis. HPB (Oxford) 2021; 23:1244-1252. [PMID: 33483260 DOI: 10.1016/j.hpb.2020.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/21/2020] [Accepted: 12/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Groove pancreatitis (GP) is a rare form of chronic pancreatitis with limited data on its diagnostics and treatment outcomes. The aim of this study was to assess its diagnostics, natural course, and treatment options. METHODS The study is a retrospective population-based study from Southern Finland, including all patients with suspected GP between January 2005 and December 2015. Two certified gastrointestinal radiologists re-reviewed the imaging studies. The radiological re-review, clinical judgment, and final histopathology confirmed the GP diagnoses. RESULTS Out of 67 patients with possible GP, 39 patients were considered to have high radiological certainty of GP. Out of these 39, five patients had cancer instead. Thirty-three patients with confirmed GP formed the final study cohort. Patients with GP were mostly middle-aged (median 55 years) men. All had at least moderate alcohol consumption. No intervention was needed in 14 patients. In five-year follow-up all conservatively treated patients became asymptomatic, while 10 out of 16 patients undergoing at least one intervention were asymptomatic at five years. CONCLUSION The radiological diagnosis of GP is difficult, and a low threshold for cancer suspicion should be kept. Symptoms of GP decrease with time and suggest conservative treatment as the first-line option.
Collapse
|
9
|
Hwang W, Nemeth K, White A, Bonomo L. Combination of ectopic pancreas and intestinal malrotation presenting as non-specific right iliac fossa pain in a SARS-CoV-2 positive patient. BMJ Case Rep 2021; 14:14/5/e241926. [PMID: 33972302 PMCID: PMC8112421 DOI: 10.1136/bcr-2021-241926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 31-year-old man who presented with a 3-day history of right iliac fossa pain with associated nausea and vomiting. He denied any previous incidents of abdominal pain and had no relevant medical history or family history to note. Given the typical history, examination findings of localised peritonism and infection risk, he was taken to theatre for laparoscopic appendicectomy without diagnostic imaging. Intraoperatively, we noted gut malrotation and an inflammatory jejunal mass which was resected after converting to a mini-laparotomy. The inflammatory mass was reported to be an ectopic pancreatic tissue from histology. Given that this patient had tested positive for SARS-CoV-2 on admission, we propose a possible case of SARS-CoV-2 infection triggering inflammation of the ectopic pancreatic tissue.
Collapse
Affiliation(s)
- Woochan Hwang
- General Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kristof Nemeth
- General Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Annabelle White
- General Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luca Bonomo
- General Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.,General Surgery, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK.,Honorary Lecturer, King's College London, London, UK
| |
Collapse
|
10
|
|
11
|
Abstract
BACKGROUND Ectopic pancreas in the ileum, including lesions within Meckel diverticulum, can cause severe manifestations and complications; yet, it was seldom reported in English literature. AIM This study aimed to raise awareness and provide information for better clinical management of this rare yet serious condition. METHODS A total of 1713 cases of small bowel resection were performed in our hospital between 2009 and 2018, among which 10 cases of ileac ectopic pancreas were identified. A comprehensive retrospective review of the 10 cases was taken. RESULTS Five lesions were located in the ileum wall and 5 were within Meckel diverticulum. Two lesions within Meckel diverticulum were incidental; the remaining 8 lesions were all associated with abdominal pain, gastrointestinal bleeding, and anemia. Of the 5 patients with lesions in the ileum wall, computed tomography uniformly revealed ileoileal intussusceptions with masses as lead points. Capsule endoscopies were performed in 6 cases, of which 3 showed positive findings. Double-balloon enteroscopy was conducted in one case and revealed an ileal diverticulum. Therapeutically, the offending bowel segments were removed, and intussusceptions were restored except for one case in which diverticulectomy was applied. No relapse or sequela was observed in the follow-up. CONCLUSIONS Ileac ectopic pancreas can be seen in the ileum wall or Meckel diverticulum. The majority of the lesions found in clinical practice present with abdominal pain, gastrointestinal bleeding, and anemia. Lesions in the ileum wall often cause ileoileal intussusception. Computed tomography, capsule endoscopy, and double-balloon enteroscopy are helpful preoperative examinations. Segmental small bowel resection is the treatment of choice.
Collapse
|
12
|
Safadi S, Martin DR, Rustagi T. Pancreatic intraepithelial neoplasia in heterotopic pancreas: incidentally diagnosed on endoscopic mucosal resection of a duodenal polyp. BMJ Case Rep 2018; 2018:bcr-2018-224414. [PMID: 29936443 DOI: 10.1136/bcr-2018-224414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heterotopic pancreas is the presence of pancreatic tissue outside its normal location. It can develop similar pathological conditions that develop in the normal pancreas, including adenocarcinoma and its precursor lesions. Due to the rarity of the condition, the diagnosis can be challenging, and treatment is not well established. We present a 47-year-old female patient referred for endoscopic resection of a 2 cm polyp in the second part of her duodenum. Complete endoscopic mucosal resection (EMR) was performed, with pathology revealing low-grade pancreatic intraepithelial neoplasia (PanIN) in heterotopic pancreatic tissue. To the best of our knowledge, this is the first case of heterotopic pancreas with low-grade PanIN in the duodenum to be incidentally diagnosed and treated with EMR.
Collapse
Affiliation(s)
- Sarah Safadi
- Department of Internal Medicine, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - David R Martin
- Department of Pathology, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| |
Collapse
|
13
|
Falckenheiner Soria J, Bernal Moreno D, Flores Rivera JM, Toro Guillen M, Lérida Vaca JL. Heterotopic Pancreas. Intestinal Obstruction Caused by a Yeyunal Intussuception. Cir Esp 2017; 96:237-239. [PMID: 29103610 DOI: 10.1016/j.ciresp.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/15/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023]
Affiliation(s)
| | - Diego Bernal Moreno
- Servicio de Cirugía General, Hospital Virgen de las Montañas, Villamartin, Cádiz, España
| | | | - Manuel Toro Guillen
- Servicio de Cirugía General, Hospital Virgen de las Montañas, Villamartin, Cádiz, España
| | | |
Collapse
|
14
|
Gastric Heterotopic Pancreas: Computed Tomography With Clinicopathologic Correlation. J Comput Assist Tomogr 2017; 41:675-678. [PMID: 28448405 DOI: 10.1097/rct.0000000000000606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Asymptomatic heterotopic pancreas (HP) is benign and can be monitored long term without further intervention. Heterotopic pancreas is sometimes surgically resected because it can be difficult to distinguish HP from neoplastic submucosal masses such as gastrointestinal stromal tumors. Although it is not very common, HP should be considered in the differential diagnosis when diagnosing extramucosal gastric masses to avoid unnecessary intervention. We review gastric HP with pathologic correlation to help with diagnosing HP on computed tomography.
Collapse
|
15
|
Diagnosis of Mesenteric Ectopic Pancreas by Secretin-Enhanced Magnetic Resonance Cholangiopancreatography. J Comput Assist Tomogr 2017; 42:236-239. [PMID: 28937483 DOI: 10.1097/rct.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ectopic pancreas (EP) is defined as pancreatic tissue found outside its usual anatomical position, with no ductal or vascular communication with the native pancreas.We report the case of a 59-year-old woman with a mesenteric jejunal EP initially suspected on computed tomography and confirmed by secretin-enhanced magnetic resonance cholangiopancreatography.Mesenteric EP is a very rare finding with nonspecific clinical presentation, so that, classic radiological findings have not been well described previously.
Collapse
|