Barbu Sorin T, Valeanu Dragos, Muresan Alexandrina, Munteanu Doru, Casoinic Florin
Chirurgia (Bucur). 2018 May-Jun;113(3):418-423. doi: 10.21614/chirurgia.113.3.418.
Cystic dystrophy of heterotopic pancreas is a benign, rare disease characterized by development of true cysts into the duodenal wall. Non-specific clinical manifestations and difficult to interpret imaging provide a diagnostic challenge, especially when pancreatic cancer is suspected. Surgical treatment (pancreatoduodenectomy) offer best outcomes.
A 48 years-old man, chronic alcohol consumer, with a history of recurrent mild acute pancreatitis episodes, was diagnosed in 2010 with segmental chronic pancreatitis complicated by a 4cm pseudocyst in the pancreatic head. He stopped drinking, but acute episodes continued to reoccur, while the pseudocyst disappeared. In 2012 the patient was admitted to our department with painful chronic pancreatitis and a new acute episode. EUS diagnosed a cystic dystrophy of the duodenal wall with groove pancreatitis, and endoscopic opening of the cysts into the duodenum was performed. Laparoscopic cholecystectomy was imposed by small gallbladder stones seen at EUS. After 6 months of silence, pain and acute episodes reappeared, imposing pancreatoduodenectomy. Patient is now well, without symptoms during 5 years of follow-up. Cystic dystrophy of heterotopic pancreas can be thought of in case of recurrent idiopathic acute pancreatitis. EUS is the best diagnosis tool, and can provide opening of the cysts into the duodenum. Surgery - pancreatoduodenectomy - offer best results.
异位胰腺的囊性营养不良是一种良性罕见疾病，其特征为十二指肠壁出现真性囊肿。非特异性临床表现以及难以解读的影像学表现给诊断带来挑战，尤其是在怀疑胰腺癌时。手术治疗（胰十二指肠切除术）效果最佳。
一名48岁男性，长期酗酒，有复发性轻度急性胰腺炎发作史，2010年被诊断为节段性慢性胰腺炎，并发胰头4厘米假性囊肿。他戒酒，但急性发作仍继续出现，同时假性囊肿消失。2012年，患者因疼痛性慢性胰腺炎和新的急性发作入院。超声内镜诊断为十二指肠壁囊性营养不良伴沟状胰腺炎，并对囊肿进行了内镜下十二指肠开窗术。超声内镜检查发现小胆囊结石，遂行腹腔镜胆囊切除术。在无症状6个月后，疼痛和急性发作再次出现，于是进行了胰十二指肠切除术。患者目前状况良好，随访5年无任何症状。对于复发性特发性急性胰腺炎病例，可考虑异位胰腺的囊性营养不良。超声内镜是最佳诊断工具，且可对囊肿进行十二指肠开窗术。手术——胰十二指肠切除术——效果最佳。
