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.
"Ectopic pancreatic tissue is an uncommon developmental anomaly and mostly occurs in the gastrointestinal tract [1, 2, 3, 4, 5, 14] and rarely in the mediastinum , the gallbladder  or the retroperitoneum . This condition is usually asymptomatic and rarely complicated by pancreatitis , gastrointestinal tract bleeding [3, 6], perforation  or malignant transformation [1, 7, 8], based on anatomical location . Although serum amylase and lipase were normal, our patient presented with severe epigastralgia with radiation to the back suggestive of acute inflammation due to pancreatic duct occlusion with the evidence of cystic change on CT and the surgical specimen . "
[Show abstract][Hide abstract] ABSTRACT: Ectopic pancreatic tissue is an uncommon developmental anomaly. The condition mostly occurs in the gastrointestinal tract and is usually asymptomatic. It rarely causes symptoms of inflammation, bleeding and perforation, and has potential for malignant change. Though it is an uncommon condition, cases of ectopic pancreas have been reported worldwide. Preoperative diagnosis of ectopic pancreas is challenging because of its nonspecific symptoms and signs. Owing to the revolution of minimally invasive surgery, submucosal tumors of the stomach can be resected by laparoscopic techniques. We have earlier reported on a case of ectopic pancreas in the stomach treated by robotics-assisted laparoscopic wedge resection. Herein, we report a case of ectopic pancreas in the prepyloric region of the stomach. A 44-year-old female presented with a two-week history of epigastralgia with radiation to the back. She received endoscopy check-up which disclosed a mass in the stomach. By endoscopic findings, a submucosal lesion in the prepyloric region with umbilical folding on the mucosa was identified. The umbilical folding on the mucosa hint the orifice of the duct of ectopic pancreas into the gastric mucosa suggestive of ectopic pancreas. Contrast-enhanced abdominal computed tomography showed a 5 cm cystic mass with heterogeneous content. To sum it up, the patient was diagnosed as ectopic pancreas in the stomach. She underwent laparoscopy-assisted antrectomy with Billroth I anastomosis (excision of the antrum and prepyloric region with reconstruction of gastrointestinal continuity by gastroduodenostomy) and had an uneventful hospitalization course. The histopathology of the resected tumor demonstrated ectopic pancreatic tissue in the gastric wall. To the best of our knowledge, excision of gastric ectopic pancreas using laparoscopy-assisted antrectomy with Billroth I anastomosis has never been reported in the literature.
Case Reports in Gastroenterology 09/2012; 6(3):712-9. DOI:10.1159/000345388
[Show abstract][Hide abstract] 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.
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