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Yang X, Liu C, Sun S, Dong C, Zhao S, Bokhary ZM, Liu N, Wu J, Ding G, Zhang S, Geng L, Liu H, Fu T, Gao X, Niu Q. Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study. Pediatr Surg Int 2024; 40:141. [PMID: 38811418 DOI: 10.1007/s00383-024-05722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
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.
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Affiliation(s)
- Xiaofeng Yang
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chen Liu
- Department of Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuai Sun
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chao Dong
- Department of General Surgery, Zibo Hospital of Shandong Yiyang Health Industry Development Group Co, Ltd, Zibo, China
| | - Shanshan Zhao
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zaitun M Bokhary
- Department of Pediatric Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Na Liu
- Department of Pathology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Jinghua Wu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Guojian Ding
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Shisong Zhang
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China.
| | - Hongzhen Liu
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China.
| | - Xiangqian Gao
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, China.
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China.
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Zanchetta M, Inversini D, Pappalardo V, Grappolini N, Morabito M, Gianazza S, Carcano G, Ietto G. Meckel's Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review-We Should Likely Resect an Incidental MD. Life (Basel) 2023; 13:1996. [PMID: 37895380 PMCID: PMC10608533 DOI: 10.3390/life13101996] [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: 09/11/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.
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Affiliation(s)
- Matteo Zanchetta
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Davide Inversini
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| | - Vincenzo Pappalardo
- Department of Surgery, Cittiglio-Angera Hospital-ASST Settelaghi, 21100 Varese, Italy
| | - Niccolo Grappolini
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Marika Morabito
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Simone Gianazza
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
| | - Giulio Carcano
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
| | - Giuseppe Ietto
- General, Emergency and Transplant Surgery Department, ASST Settelaghi, University of Insubria, 21100 Varese, Italy (M.M.)
- Department of Medicine and Innovation Technology, University of Insubria, 21100 Varese, Italy
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3
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Zhang X, Peng L, Wang Z, Pan F, Ren R, Li Y, Zhang X. Extensive heterotopic pancreas in a rare site: A case report and a review of literature. Medicine (Baltimore) 2023; 102:e32241. [PMID: 36862885 PMCID: PMC9981405 DOI: 10.1097/md.0000000000032241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE Heterotopic pancreas is a pancreatic tissue that occurs outside the normal anatomical site, the most common site is antrum. Due to the lack of specific imaging and endoscopic signs, heterotopic pancreas especially those occurring in the rare site, are often misdiagnosed, and leading to unnecessary surgical treatment. Endoscopic incisional biopsy and endoscopic ultrasound-guided fine-needle aspiration are effective means for diagnosing heterotopic pancreas. We reports a case of extensive heterotopic pancreas in a rare site, which was finally diagnosed by this way. PATIENT CONCERNS A 62-year-old man was admitted due to the presence of an angular notch lesion, which was suspected as gastric cancer before. He denied any history of tumor or gastric disease. DIAGNOSES No abnormality was found in the physical examination and laboratory testing after admission. Computed tomography showed localized thickening of the gastric wall measuring 30 mm in the long diameter. Gastroscope revealed a nodular-like submucosal protuberance at the angular notch with size of about 3*4 cm. Ultrasonic gastroscope showed that the lesion was located in the submucosa. The lesion exhibited mixed echogenicity. The diagnosis can not be identified. INTERVENTIONS 2 times of incision biopsy were performed to make a clear diagnosis. Finally, appropriate tissue specimens were obtained for pathology testing. OUTCOMES The patient was diagnosed as heterotopic pancreas according to pathology. He was recommended to undergo observation and regular follow-ups rather than surgery. Then he was discharged home with no discomfort. LESSONS Heterotopic pancreas occurring in the angular notch is extremely rare, the site is scarcely reported in the relevant literature. Therefore, it is easy to be misdiagnosed. In the cases of an vague diagnosis, endoscopic incisional biopsy or endoscopic ultrasound-guided fine-needle aspiration may be a good choice.
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Affiliation(s)
- Xiaohan Zhang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Lihua Peng
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zikai Wang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fei Pan
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Rongrong Ren
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yan Li
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiuli Zhang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- * Correspondence: Xiuli Zhang, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China (e-mail: )
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Abena Hidangmayum, Kishan Prasad H. L., Jayaprakash Shetty K., Shreesha Khandige. Asymptomatic pancreatic heterotopia in an incidental Meckel's diverticulum – A rare case report. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
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.
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Chin NH, Wu JM, Chen KC, Lee TH, Lin CK, Chung CS. Pancreatic Heterotopia in the Small Bowel: A Case Report and Literature Review. Pancreas 2022; 51:700-704. [PMID: 36206472 DOI: 10.1097/mpa.0000000000002061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Diagnosing pancreatic heterotopia (PH) is challenging, because it is a rare congenital anomaly. We report the case of a 66-year-old man who presented with ileus and jejunal PH diagnosed using single-balloon enteroscopy. Reviewing 178 cases of small intestinal PH in the literature showed that (1) PH mostly occurred at the duodenum (61.8%), followed by the jejunum (22.5%) and ileum (14.6%); (2) patients with ileal PH were younger (mean, 40.7 vs 54.6 years; P < 0.001), while those with jejunal PH were older (mean, 59.5 vs 51.7 years; P = 0.006); (3) most patients with jejunal PH were females, while those with duodenal or ileal PH were predominantly males (M:F = 0.8:1 vs 2.5:1; P = 0.003); (4) asymptomatic cases were rare (15.2% vs 83.4% in small and nonsmall bowel, respectively); (5) most patients with ileal PH presented with bleeding (61.5%), while the remaining had abdominal pain (42.8%); (6) emergent operation was performed in 11 cases (6.2%), mainly at the jejunum (12.5%) and Meckel's diverticulum (25%); and (7) Heinrich's classification may be inconclusive. Enteroscopy was performed in only 6 cases (3.4%), and earlier diagnosis and further minimally invasive procedures could have been achieved with enteroscopy.
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Affiliation(s)
- Ning-Hsuan Chin
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Jiann-Ming Wu
- Department of Surgery, Far Eastern Memorial Hospital
| | - Kuan-Chih Chen
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Tzong-Hsi Lee
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Cheng-Kuan Lin
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine
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Wang TL, Gong XS, Wang J, Long CY. Intestinal intussusception caused by intestinal duplication and ectopic pancreas: A case report and review of literature. World J Clin Cases 2022; 10:2261-2267. [PMID: 35321161 PMCID: PMC8895165 DOI: 10.12998/wjcc.v10.i7.2261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/17/2021] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intestinal intussusception caused by intestinal duplication and ectopic pancreas is extremely rare in the clinic and has not been reported previously.
CASE SUMMARY A 29-year-old man was admitted to the hospital for chronic abdominal pain and bloating. The preoperative diagnosis was intestinal obstruction and intussusception. Then, laparotomy, partial small intestinal resection and extraintestinal decompression were performed. Postoperative pathology confirmed intestinal duplication and ectopic pancreas. After surgery, the patient recovered well with no complications. No recurrence was observed after more than 5 mo of follow-up.
CONCLUSION We report a new case of a young male with intussusception caused by intestinal duplication and ectopic pancreas. Surgery is the main treatment for these conditions. This study aimed to raise awareness and provide information to improve the clinical management of this rare yet serious condition.
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Affiliation(s)
- Tao-Li Wang
- Department of Pathology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Xiao-Song Gong
- The Second Department of General Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Jin Wang
- The Second Department of General Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Chen-Yan Long
- The Second Department of General Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
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7
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Ectopic Splenic Adenocarcinoma in a Dog. J Comp Pathol 2021; 187:2-6. [PMID: 34503651 DOI: 10.1016/j.jcpa.2021.06.003] [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: 04/04/2021] [Revised: 05/10/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
A 10-year-old spayed female Border Collie developed a ductal adenocarcinoma in the spleen. Clinically, the spleen was enlarged and a small liver nodule was present but there were no other abnormalities. Most of the splenic parenchyma was diffusely infiltrated by variably shaped atypical neoplastic cells that formed small clusters or larger nests, arranged as duct or duct-like structures within a fibrous matrix. There was acinar differentiation in a few portions of the tumour with a sheet-like solid growth pattern and occasional squamous metaplasia or exocrine acinus-like structures. Mitotic figures were frequent. Neoplastic cells with ductal differentiation were diffusely immunoreactive for AE1/AE3, CAM5.2 and CK7 cytokeratins but negative for CK20, while cells with acinar differentiation were immunolabelled only for AE1/AE3 cytokeratins and were also immunopositive for mucin-1 and trypsin. A few regions of tumour with ductal or acinar differentiation were immunopositive for pancreatic lipase. All neoplastic cells were negative for mucin-2, vimentin, smooth muscle actin, chromogranin A, CD31, hepatocyte paraffin 1 and thyroglobulin antigens. Because of the formation of exocrine acinus-like structures and an immunolabelling pattern consistent with exocrine pancreas tissue, an adenocarcinoma of ectopic exocrine pancreas within the spleen was diagnosed.
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8
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Kim HS, Lee SY, Han SH, Nam SH, Jo CK, Kim MJ. Intussusception and Jejunal Atresia Caused by an Ectopic Pancreas in a Newborn. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.2.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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9
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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. Dig Dis Sci 2020; 65:2800-2804. [PMID: 32572657 DOI: 10.1007/s10620-020-06410-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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.
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Wood CG, Lopes Vendrami C, Craig E, Mittal PK, Miller FH. Pancreatitis in the developmentally anomalous pancreas. Abdom Radiol (NY) 2020; 45:1316-1323. [PMID: 31468154 DOI: 10.1007/s00261-019-02197-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Developmental anomalies of the pancreas include more common entities such as pancreas divisum and annular pancreas, and unusual entities such as heterotopic pancreas. While these anomalies can present a diagnostic challenge to the radiologist, when the pancreatic tissue involved in these processes develops pancreatitis, the radiographic appearance can present a diagnostic dilemma. Awareness of these pancreatic anomalies and familiarity with their appearance when inflamed is necessary to distinguish pancreatitis in the developmentally anomalous pancreas from other inflammatory or neoplastic processes.
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Affiliation(s)
- Cecil G Wood
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elizabeth Craig
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Pardeep K Mittal
- Department of Radiology and Imaging, Medical College of Georgia, 1120 15th Street BA-1411, Augusta, GA, 30912, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
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Abstract
BACKGROUND Ectopic pancreas in the ileum, including lesions within Meckel diverticulum, can cause severe manifestations and complications; yet, it was seldom reported in English literature. AIM This study aimed to raise awareness and provide information for better clinical management of this rare yet serious condition. METHODS A total of 1713 cases of small bowel resection were performed in our hospital between 2009 and 2018, among which 10 cases of ileac ectopic pancreas were identified. A comprehensive retrospective review of the 10 cases was taken. RESULTS Five lesions were located in the ileum wall and 5 were within Meckel diverticulum. Two lesions within Meckel diverticulum were incidental; the remaining 8 lesions were all associated with abdominal pain, gastrointestinal bleeding, and anemia. Of the 5 patients with lesions in the ileum wall, computed tomography uniformly revealed ileoileal intussusceptions with masses as lead points. Capsule endoscopies were performed in 6 cases, of which 3 showed positive findings. Double-balloon enteroscopy was conducted in one case and revealed an ileal diverticulum. Therapeutically, the offending bowel segments were removed, and intussusceptions were restored except for one case in which diverticulectomy was applied. No relapse or sequela was observed in the follow-up. CONCLUSIONS Ileac ectopic pancreas can be seen in the ileum wall or Meckel diverticulum. The majority of the lesions found in clinical practice present with abdominal pain, gastrointestinal bleeding, and anemia. Lesions in the ileum wall often cause ileoileal intussusception. Computed tomography, capsule endoscopy, and double-balloon enteroscopy are helpful preoperative examinations. Segmental small bowel resection is the treatment of choice.
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12
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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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Iwahashi S, Nishi M, Yoshimoto T, Kashihara H, Takasu C, Tokunaga T, Miyatani T, Higashijima J, Yoshikawa K, Wada Y, Bando Y, Shimada M. A case of gastric heterotopic pancreas with gastroduodenal invagination. Surg Case Rep 2019; 5:110. [PMID: 31292813 PMCID: PMC6620227 DOI: 10.1186/s40792-019-0669-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) is a rare disease commonly found incidentally on imaging studies, at endoscopy or at autopsy and can be associated with abdominal pain, vomiting, heart burn, gastric outlet obstruction, and even dysphagia in very rare cases. Heinrich's classified HP into three groups, types1-3, with Heinrich's type 3 HP the rarest and difficult to diagnose properly because it has only pancreatic ducts but has no islet and acini. The aim of this study is to report a case of gastric outlet obstruction caused by type 3 HP with gastroduodenal invagination with reference to the literature and diagnosed finally by immuno-histochemical analysis. CASE PRESENTATION The case presented is a 40-year-old male presenting with vomiting and abdominal pain. Computed tomography (CT) revealed a cystic mass in the upper abdomen and he was referred to the Tokushima University. Gastric fiber showed that the pedunculated mass originated from the stomach. An open distal gastrectomy was performed. Pathologically, there was small glands proliferation in the sub-mucosal (SM) layer which was membrane and cytoplasm (MUC)1 positive and muscle proliferation. RESULTS This finding revealed the tumor as HP. Postoperative course was uneventful and the patient was discharged 12 days after surgery. The patient has remained well 12 months after surgery. CONCLUSIONS HP should be considered in the differential diagnosis of SM tumors with gastroduodenal invagination even if this is a rare symptom.
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Affiliation(s)
- Shoko Iwahashi
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Masaaki Nishi
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan.
| | | | - Hideya Kashihara
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Chie Takasu
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Tomohiko Miyatani
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Jun Higashijima
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Kozo Yoshikawa
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Yuma Wada
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Yoshimi Bando
- Department of Division of Pathology, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
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Ahmed A, Dilip R, Khammas A, Eltayeb Y. Extraluminal heterotopic pancreatic tissue: An unusual finding. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Magenausgangsstenose bei unklarem Tumor der distalen Magenwand. Chirurg 2017; 88:1057-1058. [DOI: 10.1007/s00104-017-0464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Diagnosis of Mesenteric Ectopic Pancreas by Secretin-Enhanced Magnetic Resonance Cholangiopancreatography. J Comput Assist Tomogr 2017; 42:236-239. [PMID: 28937483 DOI: 10.1097/rct.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ectopic pancreas (EP) is defined as pancreatic tissue found outside its usual anatomical position, with no ductal or vascular communication with the native pancreas.We report the case of a 59-year-old woman with a mesenteric jejunal EP initially suspected on computed tomography and confirmed by secretin-enhanced magnetic resonance cholangiopancreatography.Mesenteric EP is a very rare finding with nonspecific clinical presentation, so that, classic radiological findings have not been well described previously.
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The Role of Laparoscopy in the Management of a Diagnostic Dilemma: Jejunal Ectopic Pancreas Developing into Jejunojejunal Intussusception. Case Rep Surg 2017; 2017:8452947. [PMID: 28819577 PMCID: PMC5551536 DOI: 10.1155/2017/8452947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/02/2017] [Indexed: 12/26/2022] Open
Abstract
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.
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Stoian S, Pop F, Strîmbu VD. Heterotopic pancreatic tissue of the stomach leading to gastric diverticulum and upper gastro-intestinal bleeding. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2016. [DOI: 10.25083/2559.5555.12.7983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Heterotopic pancreatic tissue of the stomach is a rare condition. Gastric diverticulum is also a rare condition, mostly located at the fornix. Therefore, the existence of a pyloric gastric diverticulum containing a submucosal tumor proved to be heterotopic pancreatic tissue of the stomach is an extremely rare condition. The patient was a young thin male with epigastralgia chronically treated for gastritis/ulcer. Following an episode of melena, he underwent gastroscopy that diagnosed antral gastric diverticulum containing a polyp. The lesion was surgically removed. The pathology report stated: heterotopic pancreatic tissue of the stomach with secondary development of a traction diverticulum. Heterotopic pancreas tissue of the stomach is a rare condition but the association with gastric diverticulum is completely unusual. The possibility of the ectopic tissue leading to secondary diverticulum development should be considered.
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Ruan M, Liu M, Cheng L, Xie W, Chen L. Increased 18F-FDG uptake of heterotopic pancreatitis in the small intestine: A CARE-compliant case report. Medicine (Baltimore) 2016; 95:e4465. [PMID: 27603341 PMCID: PMC5023863 DOI: 10.1097/md.0000000000004465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUD Heterotopic pancreas (HP), a relatively uncommon congenital anomaly, is rarely noted during F-FDG positron-emission tomography/computed tomography (PET/CT) scan. METHODS A 60-year-old woman was referred to our hospital due to a 10-day history of abdominal pain with elevated levels of serum amylase and lipase. Abdominal CT and ultrasound examinations were negative. In order to search for the cause, an F-FDG PET/CT whole body scan was suggested to an old woman revealing the presence of F-FDG accumulating nodule in small intestine. RESULTS Surgical findings and pathologic results confirmed the diagnosis of small intestinal heterotopic pancreas with active chronic inflammation. CONCLUSION This uncommon case underscores the necessity of considering heterotopic pancreatitis in small intestine with focal F-FDG uptake as a possible differential diagnosis in intestinal tumor and tuberculosis.
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Affiliation(s)
- Maomei Ruan
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Liu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Lingxiao Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Correspondence: Libo Chen, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (e-mail: ); Wenhui Xie, Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China (e-mail: )
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