Acute terminal pancreatitis occurring in jejunal heterotopic pancreas

Gastric Adenocarcinoma Arising from Heterotopic Pancreas Presenting as Gastric Outlet Obstruction 10 Years after the First Diagnosis

Gastric heterotopic pancreas is a relatively uncommon incidental finding. On the other hand, the presentation of gastric adenocarcinoma arising from a heterotopic pancreas is rare. This paper reports a case of gastric adenocarcinoma arising from a heterotopic pancreas that presented as a gastric outlet obstruction 10 years after the initial diagnosis of a suspicious submucosal tumor. Endoscopy revealed a pyloric stricture with prepyloric wall thickening and a complete gastric outlet obstruction. Abdominal and pelvic computed tomography exposed a severely distended gastric lumen at the antrum with heterogeneously enhancing circumferential wall thickening in the prepyloric antrum and pylorus. Because conservative treatment was ineffective and a malignancy could not be excluded, laparoscopic subtotal gastrectomy with a gastrojejunostomy was performed for histological confirmation and treatment. The histopathology diagnosis was advanced gastric carcinoma arising from heterotopic pancreatic tissue.

Diagnosis and treatment of gastric heterotopic pancreas

BACKGROUND

Heterotopic pancreas (HP) in the stomach can be difficult to diagnose and there are many treatment options. The aim of this article is to review the contemporary diagnosis of and treatment options for HP in the stomach.

METHODS

We undertook a retrospective review of patients with the diagnosis heterotopic pancreas registered at St. Olavs University Hospital in Trondheim from 1990 to 2002. We report on clinical findings, provide a histological review, and summarize the literature with particular emphasis on the diagnosis and treatment of HP in the stomach.

RESULTS

We found 32 cases, most of them in the stomach and the small intestine. Sixteen patients were symptomatic. A histological examination showed that most of the tumors were submucosal and had the appearance of normal pancreas tissue.

CONCLUSION

Gastric HP is not an uncommon diagnosis compared with many other gastric tumors and should more often be considered as a differential diagnosis. Symptom correlation is not always easy to determine, but symptom relief after treatment is well established. An endoscopic ultrasound examination may help when screening patients for extended biopsy and in deciding on which type of operation is to be performed. When treated, minimally invasive techniques should be applied.