Ectopic pancreas in the wall of intestine complicated with necrotic and inflamed intestine: A case report and review literature

Mai Van Hai1, Ngo Le Lam1, Vu Dang Luu1, Pham Minh Thong1, Do Manh Cuong2, Vu Thi Nhung3,
1 Department of Diagnostic Imaging, Bach Mai Hospital
2 Department of Surgery, Bach Mai Hospital
3 Department of Pathology, Bach Mai Hospital

Main Article Content

Abstract

SUMMARY


Background: Ectopic pancreas is a rare congenital condition characterized by pancreatic tissues located outside normal of confines
of pancreas and lacking any anatomic or vascular connection with main pancreas. It can occur anywhere in the gastrointestinal tract but
rarely are found in small intestine. Its preoperative diagnosis is difficult because the clinical symptoms are often nonspecific.We introduce a case of ectopic pancreas in the intestinal wall complicated with necrotic
and inflamed intestine, which received a treatment by resection.
Case presentation: A 44 years old man attended to Bach Mai hospital due to acute abdominal pain in epigastrium as result of gastrointestinal perforation. Contrast enhanced computed tomography (CT) of abdomen showeda mesenteric mass surrounded by inflamed
fat in the left lower quadrant abdomen. In addition, CT images also suggested necrosis of the bowel wall next to the mass caused by
twisting the mesentery and mesenteric vessels (whirlpool sign). The patient underwent local surgical resection and following histology
revealed ectopic pancreatic tissues in the wall of intestine and necrosis of intestine.
Conclusion: Although ectopic pancreas is rare, it should be considered in the differential diagnosis of a mesenteric or intestinal mass surrounded by necrotic and inflamed intestine.

Article Details

References

TÀI LIỆU THAM KHẢO
1. Lai E C and Tompkins R K (1986). Heterotopic pancreas. Review of a 26 year experience. Am J Surg, 151(6), pp. 697-700.
2. Li J, Huang H, Huo S et al (2017). Ectopic pancreatic tissue in the wall of the small intestine: Two rare case reports. Medicine (Baltimore), 96(35), pp. e7986.
3. Emerson L, Layfield L J, Rohr L R et al (2004). Adenocarcinoma arising in association with gastric heterotopic
pancreas: A case report and review of the literature. J Surg Oncol, 87(1), pp. 53-7.
4. Kinoshita H, Yamaguchi S, Shimizu A et al (2012). Adenocarcinoma arising from heterotopic pancreas in the
duodenum. Int Surg, 97(4), pp. 351-5.
5. Fukino N, Oida T, Mimatsu K et al (2015). Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum. World J Gastroenterol, 21(13), pp. 4082-8.
6. Elfbing G and Hastbacka J (1965). Pancreatic heterotopias and its clinical importance. Acta Chir Scand, 130, pp. 593-602.
7. Barbosa D E, Castro J J, Dockerty M B et al (1946). Pancreatic heterotopias: review of the literature and report of 41
authenticated surgical cases, of which 25 were clinically significant. Surg Gynecol Obstet, 82, pp. 527-42.
8. DeBord J R, Majarakis J D, and Nyhus L M (1981). An unusual case of heterotopic pancreas of the stomach. Am J Surg, 141(2), pp. 269-73.
9. Shetty A, Paramesh A S, Dwivedi A J et al (2002). Symptomatic ectopic pancreas. Clinical Review, 58, pp. 203-07.
10. Papaziogas B, Koutelidakis I, Tsiaousis P et al (2008). Carcinoma developing in ectopic pancreatic tissue in the
stomach: a case report. Cases J, 1(1), pp. 249.
11. O’Reilly D J, Craig R M, Lorenzo G et al (1983). Heterotopic pancreas mimicking carcinoma of the head of the pancreas: a rare cause of obstructive jaundice. J Clin Gastroenterol, 5(2), pp. 165-8.
12. Pang L C (1988). Pancreatic heterotopia: a reappraisal and clinicopathologic analysis of 32 cases. South Med J, 81(10), pp. 1264-75.
13. Agale S V, Agale V G, Zode R R et al (2009). Heterotopic pancreas involving stomach and duodenum. J Assoc Physicians India, 57, pp. 653-4.
14. Trifan A, Tarcoveanu E, Danciu M et al (2012). Gastric heterotopic pancreas: an unusual case and review of the literature. J Gastrointestin Liver Dis, 21(2), pp. 209-12.