Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Heterotopic Pancreas Presented as Duodenal Tumor with Obstruction

  • Kim, Sung Heun (Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Nam, So Hyun (Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine)
  • Received : 2015.04.06
  • Accepted : 2015.08.12
  • Published : 2015.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Heterotopic pancreas (HP) is defined as pancreatic tissue lacking anatomic and vascular continuity with the main body of the pancreas. Most are asymptomatic, but can cause ulcer, bleeding, intussusception, and mechanical obstruction. Herein, we presented one case of HP presented as duodenal tumor causing duodenal obstruction. A 7-year-old girl visited the emergency room for abdominal pain with vomiting for 24 hours. Computed tomography and upper gastrointestinal series revealed a polypoid mass with short stalk in the 2nd portion of duodenum. We attempted an endoscopic removal. However, the lumen was nearly obstructed by the mass and the stalk was too broad and hard to excise. The mass was surgically removed via duodenotomy. It was confirmed as a HP with ductal and acini components (type 2 by Heinrich classification). Postoperatively, the patient has been well without any complication and recurrence.

Keywords

References

  1. Lai EC, Tompkins RK. Heterotopic pancreas. Review of a 26 year experience. Am J Surg 1986;151:697-700. https://doi.org/10.1016/0002-9610(86)90045-0
  2. Tolentino LF, Lee H, Maung T, Stabile BE, Li K, French SW. Islet cell tumor arising from a heterotopic pancreas in the duodenal wall with ulceration. Exp Mol Pathol 2004;76:51-6. https://doi.org/10.1016/j.yexmp.2003.08.005
  3. Jiang LX, Xu J, Wang XW, Zhou FR, Gao W, Yu GH, et al. Gastric outlet obstruction caused by heterotopic pancreas: a case report and a quick review. World J Gastroenterol 2008;14:6757-9. https://doi.org/10.3748/wjg.14.6757
  4. De Castro Barbosa JJ, Dockerty MB, Waugh JM. Pancreatic heterotopia; review of the literature and report of 41 authenticated surgical cases, of which 25 were clinically significant. Surg Gynecol Obstet 1946;82:527-42.
  5. Kinoshita H, Yamaguchi S, Shimizu A, Sakata Y, Arii K, Mori K, et al. Adenocarcinoma arising from heterotopic pancreas in the duodenum. Int Surg 2012;97:351-5. https://doi.org/10.9738/CC148.1
  6. Jennings BS, Doerr RJ. Duodenal lipoma causing intussusception. Surgery 1989;105:560-3.
  7. Lempke RE. Intussusception of the duodenum: report of a case due to Brunner's gland hyperplasia. Ann Surg 1959;150:160-6. https://doi.org/10.1097/00000658-195907000-00020
  8. Liu YM, Shen HP, Li X, Gong JP. Heterotopic pancreas: a clinical analysis of nine patients and review of literature. Am Surg 2012;78:E141-3.
  9. Ormarsson OT, Gudmundsdottir I, Marvik R. Diagnosis and treatment of gastric heterotopic pancreas. World J Surg 2006;30:1682-9. https://doi.org/10.1007/s00268-005-0669-6
  10. Armstrong CP, King PM, Dixon JM, Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. Br J Surg 1981;68:384-7. https://doi.org/10.1002/bjs.1800680606
  11. Yoon HC, Koh YS, Kim JC, Cho CK, Kim HJ, Lee WS, et al. Ectopic pancreas presenting as a duodenal obstructing mass. J Korean Surg Soc 2005;68:65-8.
  12. Ogata H, Oshio T, Ishibashi H, Takano S, Yagi M. Heterotopic pancreas in children: review of the literature and report of 12 cases. Pediatr Surg Int 2008;24:271-5. https://doi.org/10.1007/s00383-007-2098-0
  13. Soltero MJ, Bill AH. The natural history of Meckel's diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's diverticulum found in King County, Washington, over a fifteen year period. Am J Surg 1976;132:168-73. https://doi.org/10.1016/0002-9610(76)90043-X
  14. Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ 3rd. Surgical management of Meckel's diverticulum. An epidemiologic, population-based study. Ann Surg 1994;220:564-8; discussion 568-9. https://doi.org/10.1097/00000658-199410000-00014

Cited by

  1. The Role of Laparoscopy in the Management of a Diagnostic Dilemma: Jejunal Ectopic Pancreas Developing into Jejunojejunal Intussusception vol.2017, pp.None, 2015, https://doi.org/10.1155/2017/8452947