Heterotopic pancreas without Meckel's diverticulum in children as unique cause of gastrointestinal bleeding: think about it!

Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study

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.

Co-occurrence of ectopic pancreas and superior mesenteric artery syndrome in a child: A case report and literature review

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.

Ileo-ileal intussusception and gastrointestinal bleeding caused by incidental heterotopic pancreas: four case reports

Heterotopic pancreas (HP) is a developmental anomaly defined as aberrantly located pancreatic tissue with no anatomical, vascular, or neural connection to the pancreas. Bowel intussusception and gastrointestinal bleeding caused by isolated HP is extremely rare. This study explores the clinical, radiographical, pathologic, and treatment features of four patients with intussusception caused by incidental HP, with the aim of providing important insight into the diagnosis and management of these patients. In this paper, the charts of four patients who underwent emergency laparotomy between January 2013 and August 2015 at the First Affiliated Hospital of Zhejiang University, China were reviewed. Patient demographics, presenting symptoms, blood test results, pre-operative imaging, operative procedure, and histopathology were retrospectively reviewed. All four patients, including three males and one female, presented to the emergency room with severe abdominal pain and melena. Routine blood tests revealed hemoglobin levels ranging from 75 to 128 g/L. Contrast-enhanced computed tomography (CT) confirmed lesions involving the ileum with intussusception and bowel obstruction, and all cases immediately underwent emergency laparotomy. All cases were subsequently diagnosed with HP according to histopathology. HP should therefore be considered as a rare but possible differential diagnosis for gastrointestinal bleeding and bowel intussusception, and as a possible cause of these conditions.

Concomitant Heterotopic Pancreas and Endometriosis as a Rare Cause of Ileo-Ileal Intussusception in a Young Woman with Spina Bifida: Case Report and Literature Review

INTRODUCTION

Isolated heterotopic pancreas (HP) as the primary cause of bowel intussusception is extremely rare. We report a case of a 33-year-old female patient with spina bifida admitted to the Emergency Surgical Department for ileal intussusception due to the presence of heterotopic pancreas associated with endometriosis.

AREAS COVERED

Symptomatic ileal intussusception for ectopic pancreas is usually associated with overt gastrointestinal blood loss (predominantly melena), abdominal pain, vomiting, and weight loss. Treatment is universally surgical.

EXPERT COMMENTARY

Isolated heterotopic pancreas is a rare condition; it should be considered in the differential diagnosis of bowel intussusception.