Heterotopia pancreática: análise clínico-patológica de 18 doentes

Perforation of Meckel's diverticulum by an unusual foreign body: A case report and a review of literature

Key Clinical Message

Perforation of Meckel's diverticulum (MD) is rare, particularly by foreign body. High index of suspicion and thorough intraoperative assessment is needed in patients undergoing surgery for acute appendicitis, specifically when appendix appears normal.

Abstract

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. While often asymptomatic, it can present with several complications. Perforation due to foreign body ingestion is rare but can have severe consequences if late diagnosis occurs. A 13-year-old male, initially suspected of acute appendicitis, was eventually diagnosed with perforation of MD by a wood splinter-like foreign body after intraoperative assessment. Histological analysis revealed ectopic colonic tissue within the MD, a finding whose implications are not well understood, in contrast with the well-established complications associated with ectopic gastric and pancreatic tissues. This case highlights the diagnostic challenges of MD, which can mimic acute appendicitis, emphasizing the need for high suspicion when faced with atypical clinical presentation such as foreign body-induced perforation. Although surgical resection of asymptomatic MD remains controversial, we recommend a case-specific approach based on risk factors to guide decision-making on surgical resection for asymptomatic MD.

Severe obscure gastrointestinal bleeding from Meckel's diverticulum with predominant ectopic pancreatic tissue

Obscure gastrointestinal bleeding represents about 5% of all gastrointestinal haemorrhages which is characterized by continuous or recurrent bleeding from an undetermined source after an initial bidirectional endoscopy. Meckel's diverticulum is a rare but recognized cause of obscure gastrointestinal bleeding. A carefully selected line of investigations is paramount to localize the causative lesion in obscure gastrointestinal bleeding which is a challenge in subacute cases. We present a case of 35-year-old female with thalassemia minor and mild anaemia presented with acute gastrointestinal bleeding from the ectopic pancreatic mucosa of an Meckel's diverticulum where only a small focus of gastric tissue was identified histologically during the follow-up. This case discusses the rarity of this histological presentation of Meckel's diverticulum as obscure gastrointestinal bleeding and the importance of intraoperative decision-making and intraoperative enteroscopy in cases of obscure gastrointestinal bleeding when other tests are negative.

Endoscopic Mucosal Resection of Pancreatic Rest Presenting as a Sub-epithelial Nodule in the Gastric Antrum

Pancreatic rest/ectopic pancreas is a rare condition. An 82-year-old male presented with abdominal pain and was found to have an antral nodule on esophagogastroduodenoscopy (EGD). An endoscopic ultrasound (EUS) was done and the nodule was resected. Histology showed ectopic pancreatic tissue with pancreatic intraepithelial neoplasia, PanIN-1 (low-grade dysplasia). This case highlights the importance of considering pancreatic rest as a differential in patients who present with a gastric sub-epithelial lesion and the associated finding of PanIN-1 highlights the importance of resecting such heterogeneous appearing lesions given the potential risk of progressing to pancreatic ductal adenocarcinoma (PDA).

Laparoscopic resection of an intra-abdominal esophageal duplication cyst in the ileum: a case report

BACKGROUND

Esophageal duplication cyst (EDC) is a type of gastrointestinal duplication cyst that involves congenital malformations of the gastrointestinal tract. EDCs are frequently found in the mediastinum and thoracoabdominal region, but rarely occur in the abdominal cavity. However, intra-abdominal EDCs are frequently found in the upper abdomen near the abdominal esophagus. Here, we report, for the first time, a case of intra-abdominal EDC that occurred in the ileum.

CASE PRESENTATION

A 14-year-old female patient presented to our hospital with complaints of epigastric pain and vomiting. Abdominal computed tomography (CT) revealed a cystic tumor in the pelvis, suspected of ovarian origin. She was admitted to our gynecology department and underwent emergency surgery. The laparoscopic examination revealed that both ovaries were intact and that a primary tumor had developed from the ileal mesentery. Since the patient's condition was not urgent at the time of the gynecological surgery, the procedure was completed by only performing exploratory laparotomy; the patient was admitted to our department after the surgery. Pelvic magnetic resonance imaging performed on the next day revealed a cystic mass measuring 90 × 65 mm with a smooth margin and homogeneous signal intensity, arising posterior to the uterus. The mass was suspected as an intestinal duplication cyst. On another day, after the examinations were completed, we resected the portion of the small intestine containing the tumor by laparoscopy. The patient had a successful postoperative course and was discharged on the 5th postoperative day. Histological examination showed that the cyst was lined by stratified squamous epithelium, contained esophageal glands, and had a two-layer muscularis propria. Therefore, a diagnosis of intra-abdominal EDC was performed.

CONCLUSIONS

An intra-abdominal EDC cyst is relatively rare; this is the first case reported at the distal ileum.

Intussusception Caused by Heterotopic Pancreas: A Tunisian Case Series of 5 Pediatric Patients

Heterotopic pancreas (HP) is a rare congenital developmental anomaly of the gastro-intestinal tract, defined as the presence of pancreatic tissue found in ectopic sites. Intussusception caused by isolated HP is extremely rare. Pediatric reports concerning this pathology are case reports. Here, we report cases of secondary intussusception, in which conservative treatment failed and surgery was performed. The aim of this review is to study the epidemiologic and clinical aspects of HP in pediatric patients from our institution. We retrospectively collected patients who were treated in the pediatric surgery department for intussusception caused by HP, from January 1986 to November 2018. We investigated five patients, three boys and two girls, aged 5 months to 2 years. The diagnosis was made incidentally during the operation. HP was found in the jejunum in three cases and in the ileum in two cases. HP was removed. The postoperative course was uneventful. Although rare, HP should be included in the differential diagnosis of gastrointestinal diseases, causing secondary bowel intussusception.

L., Jayaprakash Shetty K., Shreesha Khandige. Asymptomatic pancreatic heterotopia in an incidental Meckel's diverticulum – A rare case report

Pancreatic heterotopia is a rare, unusual finding where pancreatic tissues are found out of the normal anatomical location. Various studies have documented an incidence of 0.5 to 13% in autopsy. The reports on pancreatic heterotopia presence is rare, with an incidence estimated to be around 0.2% of all upper gastrointestinal surgeries. The heterotopic pancreas occurs frequnetly in the stomach, duodenum and proximal jejunum. Remote cases of  pancreatic heterotopia in Meckel's diverticulum is a rare finding. These heterotopias are  often clinically silent and are an  incidental findings  upon pathological examination or autopsy.

Ectopic pancreas with lipoma in the distal jejunum: A case report

Ectopic pancreas is asymptomatic and mostly found in the stomach and proximal small bowel. It is difficult to distinguish ectopic pancreas with other submucosal tumors of the gastrointestinal (GI) tract on computed tomography (CT) without histological confirmation. We encountered a case of ectopic pancreas coexisting with submucosal lipoma in the distal jejunum which was misdiagnosed as fat-containing submucosal tumor. We report the CT findings and review previously reported cases of ectopic pancreas coexisting with submucosal lipoma. The knowledge that ectopic pancreas can occur with benign lipoma, and its imaging features would be helpful for the diagnosis and management of patients.

Heterotopic pancreatic tissue in the gastric antrum an incidental finding during bariatric surgery: A case report and literature review

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Heterotopic pancreas, is presence of pancreatic tissue outside its normal location without anatomic continuity with the main body of the pancreas.

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The Heterotopic pancreas can be in the stomach, duodenum, jejunum, or a Meckel diverticulum.

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This is the first reported case of gastric heterotopic pancreas found during a bariatric surgery procedure.

Introduction

Heterotopic pancreas, also known as ectopic pancreas, is defined as the presence of pancreatic tissue outside its normal location and without anatomic and vascular continuity with the main body of the pancreas. The incidence of heterotopic pancreas has been reported as 0.5 % during laparotomies and at autopsy ranging from 0.6–14 %.

Presentation of case

A 28 years old obese male, medically free electively admitted for laparoscopic sleeve gastrectomy. Intraoperatively after dissecting the greater omentum from the stomach and inserting the 36 Fr gastric bougie, small oval shape mass about 1 cm close to the lesser curvature on the anterior surface of the gastric antrum. Macroscopically benign looking and a thorough laparoscopic exploration showed no signs of other organs involvement. Antrectomy and mini gastric bypass done. The postoperative course was uneventful. The histopathological examination of the antrectomy specimen showed heterotopic pancreas in the subserosa of gastric antrum.

Discussion

The Heterotopic pancreatic tissue can be discovered in the stomach (particularly antrum), duodenum, jejunum, or a Meckel diverticulum. Surgical resection is the mainstay treatment if the heterotopic pancreas is symptomatic or when the lesion is found incidentally during surgery in order to prevent complications.

Conclusion

Heterotopic pancreas should always be considered in the differential diagnosis of incidentally found gastric lesions and can be safely resected. This is the first case report of gastric heterotopic pancreas which is found incidentally during a bariatric surgery procedure.

A case report of esophageal heterotopic pancreas presenting as recurrent mediastinal abscess, treated by minimally invasive esophagectomy

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Heterotopic pancreas is a rare congenital anomaly.

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Patients may present with complications such as inflammation and abscess.

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The management depends on size, ability to exclude other etiologies and symptoms.

Introduction

Heterotopic pancreas is a rare congenital anomaly. We report a case of esophageal heterotopic pancreas complicated by recurrent mediastinal abscess and treated by minimally invasive resection.

Presentation of case

A 31-year-old woman was admitted with a history of recurrent chest pain, dysphagia, and heartburn. CT scan revealed focal confined collection in the lower mediastinum surrounding esophagus. Endoscopic ultrasound revealed a subepithelial lesion. The patient was treated by minimally invasive esophagectomy and made an uneventful postoperative recovery.

Discussion

The management of subepithelial lesions would depend on their size, ability to exclude other etiologies and their associated symptoms. The patient, in this case, was obviously symptomatic and accurate differentiation from malignant etiologies could not be accurately made.

Conclusion

Although pancreatic heterotopia is rare, it should be remembered in the differential diagnosis of various gastrointestinal lesions.

Heterotopic pancreas in the gastrointestinal tract in children: a single-center experience and a review of the literature

Background

Heterotopic pancreas, that is the abnormal localization of a well-differentiated pancreatic tissue, is a rare occurrence in pediatric patients. Most lesions are found incidentally; in some circumstances, the presence of heterotopic pancreas may cause gastrointestinal symptoms, such as obstructive symptoms or bleeding.

Patients and methods

The clinical notes of patients with histological diagnosis of heterotopic pancreas treated at Meyer Children’s Hospital between 2009 and 2017 have been retrospectively examined.

Four variables have been examined: clinical presentation, age at diagnosis, timing of surgery and localization of the heterotopic pancreas. Patients have been classified accordingly.

Results

Fourteen patients were diagnosed with heterotopic pancreas at a single institution. In half cases, heterotopic pancreas caused symptoms that warranted surgical exploration. Symptomatic patients were significantly older than patients in whom heterotopic pancreas was an incidental finding (mean age 9 years and 5 months vs 2 years and 9 months; p = 0.02). Heterotopic pancreas was more frequently found in patients who underwent urgent surgical procedure than in patients who underwent elective surgery (2.61% vs 0.22%; p < 0.0001). In all cases, foci of heterotopic pancreas were resected.

Conclusion

Heterotopic pancreas is usually discovered in the submucosa of the stomach, duodenum and small bowel. Heterotopic tissue may cause symptoms related to mechanical complications, bleeding from the surrounding intestinal mucosa or, occasionally, to the development of malignancy.

Heterotopic tissue is a rare but clinically relevant cause of gastrointestinal symptoms. The presence of heterotopic tissue should be considered in children with gastrointestinal symptoms of unclear origin and surgical resection is advisable.

Invasive ductal adenocarcinoma arising from heterotopic pancreas in the jejunum: Case report and literature review

Although the presence of pancreatic tissue outside of the usual anatomical location of the pancreas is not an uncommon incidental finding, the risk of malignancy is extremely low. We report a case of ductal adenocarcinoma arising within a focus of heterotopic pancreas, occurring in the jejunum of an 81 year old woman. The patient presented with a history of progressive gastrointestinal occlusive symptoms. Computerized tomography showed a mass in the jejunum, which was surgically removed. Histopathology revealed an invasive pancreatic ductal adenocarcinoma from pancreatic tissue with no connection with the original gland (Heinrich type II). At the 12-month follow-up, there were no signs of recurrence. Despite the low risk of malignancy in heterotopic pancreas, adenocarcinoma is the most frequent histological type, and the prognosis is still not clear. Lesions incidentally detected during surgery and in symptomatic patients need to be removed by conservative procedures in order to exclude malignant disease.

A case of ectopic pancreas in the ileum presenting as obscure gastrointestinal bleeding and abdominal pain

Background

Ectopic pancreas is an infrequent submucosal tumor in the gastrointestinal tract defined as a pancreatic tissue lacking vascular or anatomic continuity with the main body of the pancreas. Ectopic pancreas in the ileum is a rare and often an incidental finding. We report a case of ectopic pancreas in the ileum causing obscure gastrointestinal bleeding and episodes of abdominal pain.

Case presentation

59-year-old man with 3 months history of intermittent melena, accompanied by the episodes of abdominal pain in the left upper quadrant and generalized fatigue was admitted to our department. The investigations showed that the patient had a low hemoglobin level, i.e. 10.9 g/dL with hypochromic microcytic anemia pattern seen in complete blood count (MCV 70.2 fl, MCH 21.4 pg). Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities. Magnetic resonance enterography revealed a large (2.5 × 2.3 cm) pedunculated polyp in the ileum. Examination by single-balloon enteroscopy revealed a polyp with long pedicle located approximately 1.5 m distal to terminal ileum. Polypectomy was performed. Histopathologic examination stated, that the specimen contained ectopic pancreatic tissue which was involving muscular layer of the ileum. Ectopic pancreatic tissue included acinar cells and cystically dilated secretory ducts without islets of Langerhans.

Conclusion

Our case report reveals a very rare cause of obscure gastrointestinal bleeding accompanied by the episodes of abdominal pain – an ectopic pancreas located in the ileum.

CT features of asymptomatic heterotopic pancreas in jejunal mesentery

Heterotopic pancreas (HP) is localized pancreatic tissue that has no relation to orthotopic pancreas and has its own channel and vascular structures. Usually, the submucosa is located in the upper gastrointestinal tract; mesenteric placement is rarely reported. It is frequently asymptomatic and is detected incidentally in imaging, laparotomies, or autopsies. Rarely, pancreatitis may be the cause of small bowel obstruction, massive gastrointestinal bleeding, and malignant transformation. However, this has usually been reported in localized submucosal HP cases. The imaging findings are typical, and the diagnosis can be verified without the need for a histopathological diagnosis. In this case report, we aimed to present the imaging findings of asymptomatic HP located in the proximal jejunum mesentery of a 44-year-old woman. To avoid unnecessary surgical procedures, the characteristic imaging findings of HP are understood and should be considered in the differential diagnosis of masses seen in the mesentery.

Duodenal Epithelial Polyps: A Clinicopathologic Review

CONTEXT.—

Duodenal epithelial polyps are reported in 1.5% to 3% of individuals referred for upper endoscopy. Most duodenal epithelial polyps are asymptomatic and nonneoplastic; however, a small subset is neoplastic and may progress to adenocarcinoma. Recent advances in immunohistochemical and molecular techniques have helped further characterize these polyps, shedding light on their origin, classification, and risk of progression to adenocarcinoma.

OBJECTIVE.—

To provide a comprehensive clinicopathologic review of nonneoplastic and neoplastic duodenal epithelial polyps, with particular emphasis on recent developments in classification schemes and risk stratification based upon immunohistochemical and molecular profiles.

DATA SOURCES.—

This review is based on peer-reviewed literature and the authors' experiences.

CONCLUSIONS.—

In this review we provide an update on the clinicopathologic, immunohistochemical, and molecular features of duodenal epithelial polyps and discuss the surveillance recommendations and treatment options available. Particular attention should be placed on recognizing duodenal adenomas with intestinal, gastric, and serrated phenotype, as they have an increased risk of malignant transformation if not completely excised.

Pancreatic and gastric heterotopic tissue presenting as a symptomatic gallbladder mass: A case report and literature review

Pancreatic and gastric heterotopia is an uncommon congenital anomaly in which gastric and/or pancreatic tissue is found outside of its anatomic location. In the majority of patients, lesions are found incidentally because they tend to be asymptomatic. However, lesions may become symptomatic when inflammation, obstruction, and bleeding occurs. Depending on tissue size and location they can harvest a landscape of nonspecific symptoms, causing a delay in diagnosis. Heterotopic tissue of either gastric or pancreatic origin have been reported in literature, however the presence of combined gastric and pancreatic heterotopic tissue is exceedingly rare. We report a case of an 18-year-old female with polypoid gastric and pancreatic heterotopia and focal intestinal metaplasia of the gallbladder with clinical findings of acute cholecystitis. In this literature review, we synthesize the clinical significance, histopathological features, diagnosis and management of pancreatic and gastric heterotopic tissue.

Ectopic Pancreas Causing Partial Gastric Outlet Obstruction: A Case Report and Review of Literature

Ectopic pancreas is a rare cause of gastric outlet obstruction, perhaps rarer still among Africans. Although the entity is known, the diagnostic challenges are enormous, especially in the poor-resource environment. Gastric outlet obstruction resulting from ectopic pancreas in an adult is the first of its kind in our center; we, therefore, present this case to describe the challenges faced with diagnosis, treatment, and the lesson learned. Ectopic pancreas should be considered in the differential diagnosis of gastric outlet obstruction.

Heterotopic Pancreas of the Gastrointestinal Tract and Associated Precursor and Cancerous Lesions: Systematic Pathologic Studies of 165 Cases

Heterotopic pancreas (HP) can be detected by accompanying symptoms or incidentally during gastrointestinal (GI) tract tumor resection. We compared clinicopathologic features among 165 resected HPs (57 gastric [35%], 56 duodenal [34%], 30 omental [18%], and 22 jejunal [13%]). Symptomatic HPs (79/135 GI tract wall HPs, 59%) were larger (P=0.05), more common in younger patients and in a gastric location (both P<0.001), and more frequently associated with lymphoid cuffs (P=0.03) than incidentally found HPs. Gastric/jejunal HPs were more frequently symptomatic (P<0.001), deeply located (P=0.03), and associated with lymphoid cuffs (P=0.008) and pancreatic intraepithelial neoplasia/intraductal papillary mucinous neoplasms (PanIN/IPMN; P=0.001) than duodenal HPs. HP was frequently associated with acinar-ductal metaplasias (117/135 GI tract wall HPs, 87%) and PanINs/IPMNs (68/135, 50%); those with PanINs/IPMNs were larger (P<0.001), more frequently located in stomach (P=0.001), had deeper wall involvement (P=0.03), and more often showed infiltrative growth (P<0.001) and lymphoid cuffs (P=0.02). Four HPs containing PanINs abutted adenocarcinomas, all expressing wild-type KRAS and intact SMAD4/DPC4 expression. Thus, symptomatic HP is associated with younger age, larger size, gastric location, and lymphoid cuffs. HPs containing PanINs/IPMNs (usually low grade) are larger and more common in stomach, have deeper wall location, and show infiltrative growth and lymphoid cuffs. Adenocarcinomas are rarely observed adjacent to HPs with PanINs/IPMNs. KRAS mutational and SMAD4/DPC4 immunohistochemical studies can discriminate between adenocarcinoma derived from HP and concurrent adenocarcinoma with HP.

The Role of Laparoscopy in the Management of a Diagnostic Dilemma: Jejunal Ectopic Pancreas Developing into Jejunojejunal Intussusception

Ectopic pancreas (EP) is a rare congenital anomaly defined as the presence of pancreatic tissue in topographic anomaly. It is usually silent but it may become clinically evident when complicated by acute conditions. The development of laparoscopic surgery has changed the way to manage such conditions, especially in the setting of emergency surgery, thanks to its diagnostic and therapeutic role with excellent results. We decided to perform an emergency diagnostic exploratory laparoscopy in a 29-year-old man with an acute abdomen and nonspecific radiological images for intestinal occlusion. A jejunojejunal intussusception was found, caused by a mass. We decided to carry out minilaparotomy to perform a resection of the affected jejunum. Histological examination confirmed the presence of a jejunal ectopic pancreas. Adult intussusception caused by EP represents 5% of all cases of intussusception. As CT scan, especially when performed in emergency setting for small bowel obstruction diagnosis, can usually demonstrate nondiagnostic findings suggestive of intussusception of unknown origin, laparoscopic exploration could help surgeons in order to perform a resolute diagnosis and treat the pathology.

Heterotopic pancreas in the omphalomesenteric duct remnant in a 9-month-old girl: a case report and literature review

BACKGROUND

Heterotopic pancreas most commonly occurs in the upper gastrointestinal tract of adults, usually as an incidental finding. It seldom occurs at the umbilicus, and even rarely in the pediatric age group.

CASE PRESENTATION

Here we present a case of heterotopic pancreatic tissue in the omphalomesenteric duct remnant of a 9-month-old baby girl. She presented with redness at the base of the umbilicus associated with occasional mild wetness. A urachal fistula was suspected by ultrasound. Histology from subsequent resection revealed fibrous tissue with heterotopic pancreatic tissue and accompanying small bowel mucosa. The patient's umbilical redness resolved after the surgery.

CONCLUSIONS

Upon literature search, we found only 17 other cases of heterotopic pancreas reported in the umbilicus. They described a high male to female ratio, frequent association with omphalomesenteric duct remnant and presentation of umbilical discharge. The Heinrich system is frequently used to classify heterotopic pancreas into 3 types, based on the presence of acini, islets and ducts. Several mechanisms have been proposed on the pathogenesis of heterotopic pancreas, including misplacement, metaplasia and totipotent cell theories. Heterotopic pancreas can manifest clinically with diseases of the pancreas, including malignant transformation, reported as high as 12.7% in a series. Awareness of this finding in the biopsy aids the suitable treatment decisions for the patient.

Heterotopic pancreas: a clinicopathological study of 184 cases from a single high-volume medical center in China

Heterotopic pancreas (HP) is often an incidental finding during operative or endoscopic procedures and described in case reports and small series in the literature. Large clinicopathological studies with a systematic analysis remain lacking. Herein, we identified 184 (0.18%; 184/99 544) consecutive histology-proven HP cases of 89 770 surgical resections and 9774 upper endoscopic biopsies carried out at a single medical center in China. Each case was diagnosed by unequivocal identification of pancreatic acini at a location outside the pancreas. The patients' median age was 49 years (range, 14-82) with a slight female predominance (male/female ratio, 0.94). Clinical presentation at diagnosis was nonspecific. Preoperatively, most (54.9%; 101/184) HP lesions were misdiagnosed. Only 26 HP lesions (14.1%) were correctly diagnosed, all in the stomach except for 1 in the duodenum; 57 (31%) were detected during operative procedures for other conditions. The most frequent location of HP was, in descending order, the stomach (97; 52.7%), small intestine (48; 26%), lesser and greater curvature omentum (18; 10%), spleen and hilar region (5; 2.7%), porta hepatis (2; 1%), gallbladder (1; 0.5%), peridistal esophageal tissue (4; 2.2%), and mesentery (7; 3.8%). The size of HP varied from smaller than 0.5 cm (35.3%), 0.6 to 1 cm (34.8%), to larger than 1.1 cm (29.9%). Because of difficulty in preoperative diagnosis, careful workup for upper gastrointestinal diseases with HP as a differential diagnosis may increase the chance of accurate diagnosis and appropriate patient management.

Ektopinė (heterotopinė) kasa plonosios žarnos pasaite: klinikinio atvejo pristatymas ir literatūros apžvalga

Ektopinė kasa (EK) – reta įgimta anomalija, kai normalus kasos audinys yra už kasos ribų. Heterotopinis kasos audinys plonosios žarnos pasaite yra ypač retai sutinkamas EK tipas. EK dažniausiai aptinkama įvairiose virškinamojo trakto dalyse atsitiktinai.

Paprastai EK yra simptomų nesukelianti anomalija, tačiau kliniškai gali pasireikšti atsiradus komplikacijoms, tokioms kaip uždegimas, kraujavimas, obstrukcija ar supiktybėjus. Simptomų išsivystymas priklauso nuo EK dydžio, lokalizacijos bei patologinių audinio pokyčių, kurie taip pat būdingi ir normaliam kasos audiniui. Operacinis gydymas nėra indikuotinas, nebent esant komplikacijoms, todėl labai svarbi tiksli priešoperacinė diagnozė siekiant išvengti nereikalingų intervencijų.

Mes pristatome retą klinikinį atvejį, kada EK lokalizavosi plonosios žarnos pasaite. Pateikiame paciento kompiuterinės tomografijos tyrimo vaizdus. Šis klinikinis atvejis parodo, kad ektopinis kasos audinys visada turėtų būti įtrauktas į gastrointestinių navikų diferencinę diagnostiką.

Asymptomatic heterotopic pancreas in Meckel's diverticulum: a case report and review of the literature

Introduction

Heterotopic pancreas is defined as pancreatic tissue without a real anatomical or vascular connection to the pancreas. It can be found in the stomach, duodenum, jejunum, ileum, Meckel’s diverticulum, colon gall bladder, umbilicus, fallopian tube, mediastinum, spleen and liver. Complications of heterotopic pancreas are inflammation, bleeding, obstruction, malignant transformation, carcinoid syndrome, jejunojejunal intussusception and ileus, but it is usually asymptomatic and diagnosed only during examinations for other diseases.

Case presentation

An 81-year-old Lithuanian woman was diagnosed with caecal cancer and had undergone elective surgery. A right hemicolectomy was performed and a Meckel’s diverticulum was observed and excised. Histological results showed a poorly differentiated G3 adenocarcinoma of her large intestine and heterotopic pancreas tissue in the Meckel’s diverticulum and mesenteric adipose tissue.

Conclusions

Asymptomatic heterotopic pancreas is rarely diagnosed, and usually found incidentally during surgical or diagnostic interventions. Although it has no symptoms, heterotopic pancreas found during surgical procedures should be excised.

Isolated Ileal Pancreatic Heterotopia Causing Intussusception with Gangrene

Isolated ileal heterotopic pancreatic tissue as a lead point of intussusception in children is extremely rare. We report a 6-month-old female with ileoileal intussusception and a 4-year-old female with ileocolic intussusception both associated with gangrene. A review of literature suggests a higher prevalence of gangrene probably secondary to the pancreatic exocrine tissue.

Meckel's diverticulum and ectopic epithelium: Evaluation of a complex relationship

INTRODUCTION

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. Currently, for any incidentally discovered Meckel's diverticulum, the management approach is based on weighing the statistical odds of future complications against the risks of a diverticulectomy.

MATERIALS AND METHODS

The temporal relationship between age at Meckel's diverticulectomy and the presence of ectopic epithelium was evaluated in our series. A meta-analysis of all reported recent literature on this condition was subsequently performed to evaluate the strength of the relationship between ectopic epithelium and symptomatic Meckel's diverticulum.

RESULTS

There was a paucity of ectopic epithelium in Meckel's diverticulectomy specimens in infants operated on at less than 1 year of age. Having two or more ectopic epithelia in a diverticulum does not appear to carry an additive risk for complications. The meta-analysis confirmed that ectopic epithelium was the most significant factor that influenced surgical intervention in all series of Meckel's diverticulum.

CONCLUSION

The relationship between ectopic epithelium and the development of symptomatic Meckel's diverticulum is complex. Further understanding of the development of ectopic rests in the diverticulum will facilitate elucidating the pathophysiology in symptomatic cases.

Heterotopic pancreas presenting as ileoileal intussusception

Heterotopic, aberrant or ectopic pancreas is defined as the presence of pancreatic tissue in topographic anomaly, with no anatomical, neural or vascular connection to the normal pancreas. It is a rare condition found mainly in stomach, duodenum and jejunum. Ileal heterotopic pancreas is an uncommon condition and has been rarely reported in children so far. Hereby we report a case of heterotopic pancreas presenting as ileal poyp leading to ileoileal intussusception in a 12 year child.

Endoscopic ultrasonography-guided diagnosis of subepithelial tumors

Subepithelial lesions are frequently discovered during routine endoscopic examinations. These lesions represent a wide spectrum of heterogeneous benign to malignant conditions. Most of these lesions are asymptomatic. There is no consensus regarding how to manage these lesions. Over the last 2 decades, the approach to these lesions has significantly improved owing to the introduction of endoscopic ultrasonography, fine-needle aspiration, immunohistochemical staining methods, and different treatment options. This article discusses the nature of subepithelial lesions, focusing on the most recent developments that use endoscopic ultrasonography to diagnose and manage these lesions.