Tiang Ko-Ping, Ramayah Kamarajan, Yu Hang Wai, Lee Yeong Sing, Anuar Nur Arisha Binti Khairil, Koh Peng Soon
Department of Surgery, HPB Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Int J Surg Case Rep. 2024 Nov;124:110413. doi: 10.1016/j.ijscr.2024.110413. Epub 2024 Oct 3.
Heterotopic pancreas is rare and difficult to diagnose pre-operatively. Common sites for heterotopic pancreas such as the upper gastrointestinal tract, rarely involve the thorax, spleen, and kidney. Endoscopy imaging and CT imaging have been advocated to aid in diagnosis; however, they still present challenges. The majority of heterotopic pancreas patients are asymptomatic.
Our patient presented left-sided abdominal pain intermittently, each time after meals, with weight loss over the past three months. Imaging showed a small intraluminal growth at the posterior wall of the duodenum, with no metabolic activity detected from the PET scan. Given the symptomatic presentation, we proceeded with laparotomy and small bowel resection with primary anastomosis. HPE confirmed the presence of a heterotopic pancreas. Here, we discuss the management of the heterotopic pancreas and provide a literature review.
The heterotopic pancreas shares a similar genetic makeup, physiological function, and local environment exposure as the pancreas. Similar complications, such as acute or chronic pancreatitis, abscesses, pseudocyst formation, and, rarely malignancy can also occur in the heterotopic pancreas. It is often difficult to detect a heterotopic pancreas. Factors such as the site, size, and characteristics of the lesion usually aid in diagnosis, whether through endoscopy or imaging. Biopsies can be taken via endoscopy if the lesion is accessible, but most biopsies are non-diagnostic.
Heterotopic pancreas is rare and challenging to diagnose. Knowledge of common locations and characteristic imaging appearances of heterotopic pancreatic tissue aids in diagnosing. The definitive treatment is surgical resection.
异位胰腺较为罕见，术前诊断困难。异位胰腺的常见部位如上消化道，很少累及胸部、脾脏和肾脏。内镜成像和CT成像有助于诊断，但仍存在挑战。大多数异位胰腺患者无症状。
我们的患者间歇性出现左侧腹痛，每次餐后发作，且在过去三个月体重减轻。影像学检查显示十二指肠后壁有一个小的腔内肿物，PET扫描未检测到代谢活性。鉴于患者的症状表现，我们进行了剖腹手术和小肠切除术并一期吻合。组织病理学检查证实为异位胰腺。在此，我们讨论异位胰腺的治疗并进行文献综述。
异位胰腺与胰腺具有相似的基因构成、生理功能和局部环境暴露。异位胰腺也可能发生类似的并发症，如急性或慢性胰腺炎、脓肿、假性囊肿形成，很少发生恶性肿瘤。异位胰腺通常难以检测。病变的部位、大小和特征等因素通常有助于通过内镜或影像学进行诊断。如果病变可及，可通过内镜进行活检，但大多数活检无法确诊。
异位胰腺罕见且诊断具有挑战性。了解异位胰腺组织的常见位置和特征性影像学表现有助于诊断。 definitive treatment为手术切除。 （注：原文中“definitive treatment”直接保留英文，可能有误，推测应为“决定性治疗”之类表述，按照要求未修改。）
