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Sefefe WM, Tesfaw DB, Tebikew AD, Ayenew AS, Dencha BA, Abebe TA. Jejunal Ectopic Pancreatic Tissue Rest as Lead Point in Patients with Intussusception: A Rare Case Report and Review of Literature. Clin Exp Gastroenterol 2024; 17:135-139. [PMID: 38708058 PMCID: PMC11067941 DOI: 10.2147/ceg.s425986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background Ectopic pancreas (EP), characterized by pancreatic tissue outside its usual location, poses diagnostic challenges due to its asymptomatic nature in most cases. Gastric lesions are often symptomatic, causing epigastric pain or gastric outlet obstruction. Rarely, jejunal lesions can lead to intestinal obstruction or intussusception. The elusive preoperative diagnosis lacks specific biochemical markers, relying on intraoperative biopsy and histopathology as gold standards. Case Presentation We present a unique case of a 37-year-old female with 12-hour crampy abdominal pain, bilious vomiting, blood-mixed diarrhea, abdominal distension, and obstructive symptoms. Imaging revealed jejunojejunal intussusception with a jejunal mass as the lead point. Intraoperatively, also identified jejunal mass as lead point. Resection of mass and end-to-end jejunojejunal anastomosis were performed, resulting in a successful outcome. Histopathological examination identified a type I ectopic pancreas within the muscularis propria. Twelve months postoperatively, the patient exhibited no stricture or recurrence. Conclusion Ectopic pancreas, with varied symptoms, poses diagnostic hurdles. Despite the diagnostic challenges, surgical excision remains the optimal treatment for symptomatic cases. This report contributes to the limited literature on ectopic pancreas, emphasizing the importance of considering this entity in the differential diagnosis of gastrointestinal pathology.
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Affiliation(s)
- Worku Mekonnen Sefefe
- Department of Surgery, Debre Markos University (DMU), Debre Markos, Amhara, Ethiopia
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Bajour D, Haddad S, Marina S, Zoukar S, Haddad S, Martini N, Khouri L. Co-occurrence of ectopic pancreas and superior mesenteric artery syndrome in a child: A case report and literature review. SAGE Open Med Case Rep 2023; 12:2050313X231220830. [PMID: 38162423 PMCID: PMC10757443 DOI: 10.1177/2050313x231220830] [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] [Received: 06/30/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
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.
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Affiliation(s)
- Dina Bajour
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Salim Haddad
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Sliman Marina
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Sham Zoukar
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Sultaneh Haddad
- Aleppo University, Faculty of Medicine, Aleppo, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Nafiza Martini
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Lina Khouri
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Departement of Pediatrics at Children’s Hospital, Damascus, Syrian Arab Republic
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Zhang T, Yin SF, Wang QW, Feng WB, Ke CX. Case Report: The ectopic pancreas in the adrenal glands: It was found due to elevated blood pressure and initially diagnosed as adrenal adenoma. Front Surg 2022; 9:1040711. [PMID: 36406378 PMCID: PMC9669272 DOI: 10.3389/fsurg.2022.1040711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background The ectopic pancreas is a kind of congenital malformation formed during embryonic development, which has no anatomical relationship with the normal pancreas and is a rare solid disease. The ectopic pancreas in the adrenal glands is extremely rare. Case summary A 32-year-old man was admitted to the hospital after experiencing elevated blood pressure for 2 years as well as dizziness and blurred vision for 2 weeks. He had an elevated blood pressure of 170/110 mmHg (1 mmHg = 0.133 kPa) on physical examination 2 years ago, without palpitations, chest pain, and chest tightness. Two weeks ago, he presented with dizziness and blurred vision. Blood renin and aldosterone levels were elevated. Plain CT and contrast-enhanced CT scan showed nodular thickening of the left adrenal and homogeneous enhancement, which was initially considered adrenal adenoma. The postoperative pathology supported the ectopic pancreas in the left adrenal. After 78 months of postoperative follow-up, no recurrence was observed, but his blood pressure remained persistently high. Conclusion The ectopic pancreas occurring in the adrenal glands is extremely rare, has no specific clinical symptoms, and is mainly found for other reasons. It can easily be misdiagnosed as an adrenal adenoma. The final confirmation of the diagnosis still depends on the pathological biopsy. A great deal of reporting is still required for whether there is a correlation with elevated blood pressure.
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Affiliation(s)
- Tao Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Si-fan Yin
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qi-wu Wang
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Wen-bo Feng
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang-xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Correspondence: Chang-Xing Ke
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Saeed MF, Verhagen KR, Albinali S, Juma IM. A case report and literature review: incidental jejunal ectopic pancreatic tissue in an emergency bowel exploration for suspected intussusception. AME Case Rep 2019; 3:24. [PMID: 31463429 DOI: 10.21037/acr.2019.07.05] [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: 02/15/2019] [Accepted: 06/27/2019] [Indexed: 11/06/2022]
Abstract
Heterotopic pancreas (HP) is defined as pancreatic tissue which is an anatomically separate entity from the main pancreas and free from the organ's vascular or ductal continuity. Most cases of HP are asymptomatic and are diagnosed incidentally upon laparotomy or on autopsy. The diagnosis of HP can be extremely difficult. A few imaging modalities which include Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) may show characteristic features of HP. However, definitive diagnosis is made by histopathology. Conversely, these modalities may not differentiate a malignant neoplasm from a benign mass. Surgical excision is thought to be curative for HP. In this case report, we present a 62-year-old female with acute myelocytic leukemia on induction chemotherapy who developed abdominal pain during her hospital admission and was referred to the general surgery department. Abdominal computed tomography (CT) was done and showed signs of small bowel obstruction, perforation, and overlapping jejunoileal segments suggestive of intussusception. Upon surgical exploration two small bowel perforations were repaired, one iatrogenic and one pathological. On bowel run a jejunal mass was found, excised, and upon histopathology confirmed to be a mixed endocrine and exocrine heterotopic pancreatic choristoma. Definitive diagnosis of heterotopic pancreatic tissue is made by histopathology, and surgical excision is potentially curative. In conclusion, we recommend excising HP if found incidentally upon surgery as the diagnosis of HP and exclusion of neoplasm may not be possible without a histological specimen.
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Affiliation(s)
- Mirza Faraz Saeed
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Bahrain
| | - Kiara Rebekka Verhagen
- Department of Obstetrics and Gynaecology, King Hamad University Hospital, Busaiteen, Bahrain
| | - Sultan Albinali
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Bahrain
| | - Isam Mazin Juma
- Department of Surgery, King Hamad University Hospital, Busaiteen, Bahrain
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Abstract
INTRODUCTION Hepatoid adenocarcinoma (HAC) is a rare neoplasm with a striking morphologic similarity to hepatocellular carcinoma. The most common sites of HAC are the stomach, lung, and pancreas. CASE REPORT Here we report a rare case of HAC arising from the heterotopic pancreas (Heinrich type II) in the ileum with lymph node metastasis. A 56-year-old man was admitted to our hospital presenting with bloody stools under no obvious predisposing causes. The colonoscopy and the gastroscopy showed no pathological findings. A computed tomography scan showed an intussusception of ileum. Then partial resection of ileum was performed with end-to-end anastomosis and appendectomy. Histopathological examination showed a malignant transformation of heterotopic pancreas (Heinrich type II) in the ileum. We made the diagnosis of HAC based on clinical pathological features and immunochemical staining. The patient received chemotherapy and died 9 months later. CONCLUSION To our best knowledge, this is the first reported case of HAC originated from a heterotopic pancreas in the ileum. The clinical pathological features and immunochemical staining are important for correct diagnosis of HAC.
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Affiliation(s)
- Ling Tong
- Department of Pathology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia Autonomous Region
| | - Huaxiong Pan
- Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun He
- Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mixia Weng
- Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liduan Zheng
- Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence to: Liduan Zheng, Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 of Jiefang Avenue, Wuhan 430022, China (e-mail: )
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