Image of the month. A gastric heterotopic pancreas with cystic change

Gastric perforation and generalized peritonitis due to heterotopic pancreas, an unusual case report

INTRODUCTION

Heterotopic pancreas is the presence of normal pancreatic tissue that is in an anatomical site different from the pancreas.

CASE REPORT

Adolescent who was admitted to the emergency room due to intense, generalized abdominal pain, which did not go away with anything, was exacerbated with movements, 24 h later vomiting that occurred as soon as he ate food was added, and severe and progressive abdominal distention, reason for admission to the service of emergencies. He had no significant family or personal medical history. On physical examination, he was found to be sick with a painful appearance, pale, sweaty, feverish, with tachycardia, he complained of intense pain, distended abdomen, with loss of hepatic dullness, with involuntary muscular resistance, with positive rebound sign, absent peristalsis. Laboratory studies were taken that reported anemia, leukocytosis and neutrophilia, blood chemistry, electrolytes, and coagulation times within normal limits; abdominal x-rays showed subdiaphragmatic free air.

DISCUSSION

The prevalence of pancreatic heterotopia in the literature varies from 0.6 % in autopsy series to 14 %, however, the increasingly frequent use of upper gastrointestinal endoscopy and endoscopic ultrasound allows early diagnosis, since whether directed or incidentally, which avoids serious complications such as gastric perforation, because it is unusual for it to occur as in this clinical case. Specifically in the stomach, involvement of the submucosa layer has been described in 73 %, muscular layer in 17 % and subserosa in 10 % of cases respectively. In cases where the disease is in an asymptomatic stage, it can be treated conservatively; it seems to be more common in men, as in our case, than in women.

CONCLUSION

In patients with chronic epigastric pain, it is essential to rule out conditions such as heterotopic pancreas, to avoid serious complications such as perforation.

Heterotopic Pancreatic Tissue of the Stomach: Report of Three Cases and Consideration of Its Histogenesis

Heterotopic pancreatic tissue of the stomach is a rare condition. The author herein reports three cases of heterotopic pancreatic of the stomach. The three cases were found in the 8,154 gastric specimens (biopsy 6,122 cases, gastrectomy 2,032 cases) of our pathology laboratory; the frequency was 0.04%. The first case was a 57-year-old woman who presented with epigastralgia. Endoscopic examination revealed a submucosal tumor in the body of the stomach. Partial gastrectomy was performed. Histologically, the lesion measured 25 × 20 × 25 mm and was submucosal heterotopic pancreatic tissue with hemorrhage and cystic changes. It was composed of acinar cells, ducts, and islets (Heinrich type I). The second case was a 57-year-old man without symptoms. Endoscopic examination revealed a submucosal tumor, and biopsy was taken. The biopsy showed heterotopic pancreatic tissue in the mucosa. It consisted of acinar cells and ducts (Heinrich type II). The third case was a 54-year-old woman without symptoms. Endoscopic examination showed chronic gastritis, and biopsy was obtained. The biopsy revealed heterotopic pancreatic tissue in the mucosa. It consisted of acinar cells and ducts (Heinrich type II). The first case appears to be a true heterotopic pancreas of congenital abnormality. The second and third cases seem to be heterotopic pancreatic tissues of congenital anomaly of the gastric mucosa. The histogenesis of heterotopic pancreatic tissue is discussed.

Cystic dystrophy in gastric heterotopic pancreas complicated by intracystic hemorrhage and fistulisation in the stomach - a pediatric case

CONTEXT

Cystic dystrophy of the digestive wall, a rare but well-known complication of heterotopic pancreas when it is located in the duodenum, has been mainly described in adult series. Cystic dystrophy of the heterotopic pancreas within the gastric wall has been reported in only six adult cases. To our knowledge, no pediatric case has been described.

CASE REPORT

We report a 15-year-old boy surgically treated for cystic dystrophy located in the antrum, complicated by an intracystic hemorrhage and fistulisation into the stomach.

CONCLUSION

The diagnosis of heterotopic pancreas must be considered in case of submucosal cystic-gastric lesions, even in pediatric cases. Although the surgical approach is not systematic, it is recommended when cystic dystrophy is symptomatic (e.g., occlusion or hemorrhage).

Cystic dystrophy of heterotopic pancreas in stomach: radiologic and pathologic correlation

Cystic dystrophy of heterotopic pancreas is a rare condition that means cystic changes of normal pancreatic tissue, placed in unusual locations, commonly in the duodenal wall. We report a case of CDHP in stomach, histologically confirmed after surgery. We show the correlation between radiological and anatomopathological findings, and also review the current literature about reported cases of this exceptional disease.