Perforation of jejunal diverticulum with ectopic pancreas

Laparoscopic surgery for duodenal perforation due to a diverticulum with heterotopic pancreas: a case report

BACKGROUND

Heterotopic pancreas (HP) refers to the presence of abnormally located pancreatic tissue without any anatomic or vascular continuity with the main body of the pancreas. HP can occur in the gastrointestinal tract and be complicated by gastrointestinal bleeding, pancreatitis, obstruction, or malignant generation. Specifically, perforation of the gastrointestinal tract because of HP is extremely rare.

CASE PRESENTATION

A 91-year-old woman was diagnosed with duodenal perforation, and an emergency laparoscopic operation was performed. The operative findings indicated a tumor and duodenal wall perforation. The tumor and the perforated site were resected with a linear stapler. Histopathological examination revealed the presence of HP tissue in the submucosal layer around the diverticulum without any signs of inflammation. The perforated site was not covered by HP tissues, and the duodenal wall might have been weaker than the other areas, which could have caused the internal pressure to increase and led to the perforation.

CONCLUSIONS

Preoperative HP diagnosis is difficult, and it is crucial to consider HP as the differential diagnosis in gastrointestinal perforations. The duodenal diverticula can be perforated due to increased internal pressure of the duodenum caused by the imbalanced localization of HP.

A Case of Perforated Jejunal Diverticulum: An Unexpected Cause of Pneumoperitoneum in a Patient Presenting with an Acute Abdomen

Patient: Female, 74

Final Diagnosis: Perforated jejunal diverticulum

Symptoms: Abdominal pain • Nauseas • Vomits

Medication: —

Clinical Procedure: —

Specialty: Surgery

Ectopic pancreatic tissue in the wall of the small intestine: Two rare case reports

RATIONALE

Ectopic pancreas, which is a kind of rare congenital disease, forms during embryonic development. It can occur throughout the whole gastrointestinal tract, but has a low tendency to develop in the wall of the small intestine. It is easy for patients with ectopic pancreases to be misdiagnosed because the symptoms are untypical and can vary.

PATIENT CONCERNS

In the present study, we reported two rare cases of ectopic pancreatic tissue in the wall of the small intestine, which presented with obvious abdominal pain and distention.

DIAGNOSIS

The laboratory tests and computed tomography (CT) scans didn't reveal any evidence of ectopic pancreas.

INTERVENTIONS

The two patients received small intestine masses resection and intestinal anastomosis.

OUTCOMES

During surgery, an intestinal mass with a diameter of 4.0 cm was found in the first patient. An intestinal mass with a diameter of 0.8 cm, jejunum perforation, and diffuse peritonitis were found in the second patient. Histological analyses of the dissected intestinal masses confirmed them as ectopic pancreatic tissue. Interestingly, for the second patient, the intestinal perforation and diffuse peritonitis were not induced by the ectopic pancreas, but by a jujube pit that was found in the perforated site of the intestine.

LESSONS

Our study demonstrated that an ectopic pancreas should be considered in cases of untypical abdominal symptoms with intestinal masses.