Endoscopy 2010; 42: E121
DOI: 10.1055/s-0029-1243988
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Heterotopic pancreas: a difficult diagnosis

G.  Payeras1 , C.  Castellón2 , J.  De Jaime2 , R.  Barranco1 , A.  Calvache1 , P.  Castro1
  • 1Digestive Endoscopy Unit, Department of Gastroenterology, Hospital Infanta Elena, Madrid, Spain
  • 2Department of Surgery, Hospital Infanta Elena, Madrid, Spain
Further Information

Publication History

Publication Date:
19 March 2010 (online)

A 45-year-old man was admitted to our hospital complaining of epigastric pain and nausea for 2 days. He had no history of systemic disease. Laboratory tests at admission, including amylase, were normal except for a 12 100/mm3 leucocyte count (89 % polymorphonuclear). Abdominal ultrasonography revealed an irregular, hypoechoic solid lesion of 37 × 28 mm, and computed tomography scan showed a 37-mm, thick-walled, extraluminal cystic lesion.

Gastroscopy revealed a submucosal lesion at the antrum of the stomach with a necrotic eschar on its surface ([Fig. 1]; [Video 1]). Endoscopic ultrasonography showed a heterogeneous lesion suggesting muscular layer necrosis. The patient was successfully treated surgically by subtotal gastrectomy. Pathological examinations confirmed a diagnosis of aberrant pancreas ([Fig. 2]).

Fig. 1 Gastroscopy revealed a submucosal lesion at the antrum of the stomach.


Quality:

Video 1 Gastroscopy revealed a submucosal lesion at the antrum of the stomach with a necrotic eschar on its surface.

Fig. 2 Pathological examination confirmed a diagnosis of aberrant pancreas.

Heterotopic pancreas is the presence of pancreatic tissue lying outside of its normal location and lacking anatomic or vascular connections with the pancreas [1]. It is located in the antrum in 85 % – 95 % of cases, and it is usually asymptomatic but may become clinically evident depending on the size, location, and the pathological changes [2]. In some cases, because the findings on imaging studies are not specific for aberrant pancreas, its preoperative definitive diagnosis is difficult [3]. The definitive diagnosis of aberrant pancreas is attained on histopathological examination and it should always be considered in the differential diagnosis of gastric masses.

Competing interests: None

Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB

References

G. Payeras, MD 

Digestive Endoscopy Unit
Department of Gastroenterology
Sanatorio San Fco. Asis

Joaquin Costa 28 Madrid
Madrid 28002
Spain

Fax: +34-91-4113839

Email: gpayeras@yahoo.es