Matsumoto Takatsugu, Tanaka Nobutaka, Nagai Motoki, Koike Daisuke, Sakuraoka Yuki, Kubota Keiichi
1 Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
Int Surg. 2015 Apr;100(4):678-82. doi: 10.9738/INTSURG-D-14-00182.1.
Heterotopic pancreas (HP) is a rare entity which is defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the pancreas. It is most commonly found along foregut derivatives, such as the stomach, duodenum, and jejunum. It is frequently encountered incidentally in asymptomatic patients, and symptomatic patients are rare and do not exhibit any specific symptoms. Accordingly, HP is difficult to diagnose before surgery. Here we report an unusual case of gastric heterotopic pancreatitis causing gastric outlet obstruction diagnosed preoperatively using endoscopic ultrasonography guided fine needle aspiration cytology. A 21-year-old woman was referred to our hospital because of abdominal pain, nausea, and vomiting. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor in the gastric body. Contrast-enhanced computed tomography (CT) revealed that the tumor had a cystic component and marked perigastric inflammation. Endoscopic ultrasonography (EUS) demonstrated a hypoechoic mass arising from the third to fourth layer of the gastric wall. Pancreatic exocrine glands were detected by EUS-guided fine needle aspiration biopsy. The lesion was diagnosed as gastric heterotopic pancreas with inflammation of the pancreatic tissue. Laparoscopic partial gastrectomy was performed, and the diagnosis was also histologically confirmed. The patient was discharged 5 days after the operation. She has remained healthy and symptom-free during 10 months of follow-up. We experienced a first case of gastric heterotopic pancreatitis which was correctly diagnosed preoperatively and resected by laparoscopic surgery. Partial resection of the heterotopic pancreatic tissue could lead to a good outcome.
异位胰腺（HP）是一种罕见的实体，其定义为存在与胰腺缺乏解剖学和血管连续性的胰腺组织。它最常见于前肠衍生物，如胃、十二指肠和空肠。它经常在无症状患者中偶然发现，有症状的患者很少见，且不表现出任何特定症状。因此，HP在手术前很难诊断。在此，我们报告一例罕见的胃异位胰腺炎导致胃出口梗阻的病例，该病例术前通过内镜超声引导下细针穿刺细胞学检查得以诊断。一名21岁女性因腹痛、恶心和呕吐被转诊至我院。胃十二指肠内镜检查发现胃体部有一个椭圆形黏膜下肿瘤。增强计算机断层扫描（CT）显示该肿瘤有囊性成分且胃周有明显炎症。内镜超声（EUS）显示一个低回声肿块起源于胃壁的第三至第四层。通过EUS引导下细针穿刺活检检测到胰腺外分泌腺。该病变被诊断为胃异位胰腺伴胰腺组织炎症。实施了腹腔镜部分胃切除术，组织学检查也证实了诊断。患者术后5天出院。在10个月的随访期间，她一直保持健康且无任何症状。我们遇到了首例胃异位胰腺炎，术前得到正确诊断并通过腹腔镜手术切除。异位胰腺组织的部分切除可带来良好的治疗效果。
