Abel R, Keen C E, Bingham J B, Maynard J, Agrawal M R, Ramachandra S
Department of Paediatric Surgery, University Hospital Lewisham, London SE13 6LH, UK.
Pediatr Dev Pathol. 1999 Jul-Aug;2(4):367-70. doi: 10.1007/s100249900136.
Two cases of intussusception are reported with heterotopic pancreatic tissue attached to and draining into the ileum. The first patient, a boy aged 16 months, presented with ileoileal intussusception. The diagnosis was confirmed on ultrasound scan. Laparotomy and resection were performed. A 12-mm nodule of heterotopic pancreatic tissue was identified in the ileal serosa at the apex of the intussusceptum, fully formed with acinar tissue, islets, and draining duct. The second patient, also a boy aged 16 months, presented with obstructed ileocolic intussusception in which the lead point at surgery resembled a Meckel's diverticulum. Histopathology revealed a similar 10-mm nodule of fully formed pancreatic tissue in the ileal serosal tissues, with some acinar tissue extending through the wall of the intestine alongside ductal structures. In both cases there was ectopic gastric mucosa either in the distal part of the draining duct or in the small intestine itself at the opening. Heterotopic pancreas is a rare cause of intussusception. We propose that this lesion is of vitellointestinal tract origin, conceptually similar to a Meckel's diverticulum but without a diverticulum as such. Heterotopic pancreatic tissue occurring alone is more common in the proximal small intestine, duodenum, and stomach than in the ileum, and it is often asymptomatic.
报告了两例肠套叠病例，其异位胰腺组织附着于回肠并向回肠引流。首例患者为一名16个月大的男孩，表现为回肠-回肠型肠套叠。超声扫描确诊。行剖腹手术及切除术。在肠套叠顶端的回肠浆膜层发现一个12毫米的异位胰腺组织结节，由腺泡组织、胰岛和引流导管完全构成。第二例患者也是一名16个月大的男孩，表现为梗阻性回结肠型肠套叠，手术中的套入点类似梅克尔憩室。组织病理学显示在回肠浆膜组织中有一个类似的10毫米完全形成的胰腺组织结节，一些腺泡组织与导管结构一起延伸穿过肠壁。两例病例在引流导管远端或开口处的小肠本身均有异位胃黏膜。异位胰腺是肠套叠的罕见病因。我们认为这种病变起源于卵黄管肠道，在概念上类似于梅克尔憩室，但本身没有憩室。单独出现的异位胰腺组织在近端小肠、十二指肠和胃中比在回肠中更常见，且通常无症状。
