Fukuda Junki, Shibata Akira, Ohashi Ryosuke, Hane Yuma, Saito Takahiro, Nishigami Kohei, Senmaru Naoto, Fujita Miri, Hirano Satoshi
Department of Surgery, Steel Memorial Muroran Hospital, Muroran, Hokkaido, Japan.
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0018. Epub 2025 Apr 29.
Heterotopic pancreas refers to pancreatic tissue located outside its normal position and lacking anatomical or vascular continuity with the pancreas. Gastric heterotopic pancreas (GHP) is generally asymptomatic, but in rare cases large GHP lesions can cause gastric outlet syndrome or gastroduodenal invagination. GHP may also occasionally cause acute pancreatitis and abscess formation in the gastric wall. This report describes a rare case of GHP with concurrent gastroduodenal invagination and gastric wall abscess treated via laparoscopic distal gastrectomy.
A 46-year-old man was admitted to the hospital with abdominal pain and vomiting. Computed tomography revealed a 40-mm low-density mass in the gastric pylorus, and gastroduodenal invagination. Gastroscopy confirmed a submucosal lesion at the gastric pylorus causing pyloric stenosis. The patient underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction. Histopathological examination revealed a gastric submucosal lesion containing pancreatic tissue with acinar cells and ducts, without islets of Langerhans, leading to a diagnosis of Heinrich type II GHP. The submucosal lesion also contained inflammatory components such as neutrophils and foamy histiocytes, forming a gastric wall abscess. Finally, the patient was discharged on postoperative day 11 and is progressing well 7 months after surgery.
Herein we report the first case of laparoscopic distal gastrectomy for GHP with concurrent gastroduodenal invagination and gastric wall abscess resulting in a favorable outcome.
异位胰腺是指位于正常位置以外且与胰腺缺乏解剖学或血管连续性的胰腺组织。胃异位胰腺（GHP）通常无症状，但在罕见情况下，较大的GHP病变可导致胃出口综合征或胃十二指肠套叠。GHP偶尔也可引起急性胰腺炎和胃壁脓肿形成。本报告描述了一例通过腹腔镜远端胃切除术治疗的并发胃十二指肠套叠和胃壁脓肿的罕见GHP病例。
一名46岁男性因腹痛和呕吐入院。计算机断层扫描显示胃幽门处有一个40毫米的低密度肿块以及胃十二指肠套叠。胃镜检查证实胃幽门处有一个黏膜下病变导致幽门狭窄。患者接受了腹腔镜远端胃切除术并进行了Roux-en-Y重建。组织病理学检查显示胃黏膜下病变包含有腺泡细胞和导管的胰腺组织，但无胰岛，诊断为海因里希II型GHP。黏膜下病变还包含中性粒细胞和泡沫状组织细胞等炎症成分，形成了胃壁脓肿。最后，患者术后第11天出院，术后7个月恢复良好。
在此我们报告首例通过腹腔镜远端胃切除术治疗并发胃十二指肠套叠和胃壁脓肿的GHP并取得良好疗效。
