Recurrent ectopic pancreatitis of the jejunum and mesentery over a 30-year period.
ABSTRACT Ectopic pancreas is defined as pancreatic tissue found outside its usual anatomical position, with no ductal or vascular communication with the native pancreas. We describe a case of ectopic pancreas of the small bowel and mesentery causing recurrent episodes of pancreatitis, initially suspected on computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), and confirmed on histological review of the resection.
A 67-year-old woman presented with clinical symptoms and biochemical evidence of pancreatitis. She had similar episodes over the past 30 years with unrevealing investigations, and was concluded to have idiopathic pancreatitis. She underwent CT and MRCP, with findings suggestive of ectopic pancreas, a diagnosis confirmed on histology of the resection.
MRCP identified a mass in the proximal small bowel mesentery isointense to the native pancreas, with a small duct draining into a proximal jejunal loop. The resected specimen consisted of normal parenchyma with lobulated acinar tissue with scattered islets of Langerhans, an occasional ductular structure, and admixed areas of adipose tissue. The patient remained asymptomatic with normal biochemistry six months post-operatively.
In an individual with abdominal pain, elevated serum amylase/lipase, but imaging findings of a normal native pancreas, ectopic pancreatitis should be considered, and can be evaluated by CT and MRCP.
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ABSTRACT: To evaluate computed tomography (CT) findings of heterotopic pancreas of the mesentery (HPM). Two radiologists reviewed CT scans of seven patients with HPM to determine the location, relationship with the adjacent bowel, presence of a duct-like structure, and the enhancement pattern of HPM in consensus. All HPMs were located in the jejunal mesentery and had morphologic features closely resembling those of the main pancreas and had unique relationship with the jejunum. Duct-like structures were observed in five lesions. The enhancement pattern varied. It is important to be aware of characteristic CT features of HPM to eliminate unnecessary surgeries.Clinical imaging 10/2013; 38(1). DOI:10.1016/j.clinimag.2013.09.008 · 0.73 Impact Factor
- Seminars in roentgenology 07/2013; 48(3):188-191. DOI:10.1053/j.ro.2013.03.011 · 0.70 Impact Factor
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ABSTRACT: To investigate the computed tomography (CT) features of heterotopic pancreas of the jejunum (HPJ) and to assess their associations with HPJ pathology features. In this retrospective series analysis, two radiologists reviewed the CT images of 17 patients with surgically proven HPJ in order to determine in consensus the location, long diameter, margin, shape, contour, and growth pattern of the lesions, the presence of a duct-like structure, the lesion enhancement patterns, including the homogeneity, and the degree of contrast enhancement compared with that of the main pancreas. The pathology features of the surgical specimens were reviewed and their associations with the CT features were assessed. On CT, the HPJs typically appeared as a small (< 3 cm), well-defined, ovoid or flat-shaped mass in the proximal jejunum with multiple and tiny lobulations. The growth pattern varied and the duct-like structure was rarely visible. The HPJs mostly appeared to be homogeneous and exhibited hyper- or isoattenuation compared to the main pancreas in the arterial and portal phases. However, these enhancement patterns varied slightly depending on the microscopic composition of the lesions (i.e., acinar vs. ductal predominance). Most HPJs comprised histologically of large acini, some ducts, and small islet cells, and had ductal communication with the jejunum. HPJs typically manifested as small, well-defined, ovoid or flat-shaped, homogeneous, and well-enhancing masses with a microlobulated contour in the proximal jejunum on CT, and their enhancement patterns associated with their microscopic composition. The pathology features of HPJs generally mimic those of the normal pancreas.Abdominal Imaging 06/2014; 40(1). DOI:10.1007/s00261-014-0177-y · 1.73 Impact Factor