A case of gastric heterotopic pancreatitis resected by laparoscopic surgery

Abstract

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.

Keywords: Laparoscopic surgery; Pancreatitis; Stomach.

Fig. 1

Large submucosal lesion in the antrum obstructs the gastric outlet.

Fig. 2

Contrast-enhanced computed tomography scan demonstrates a large submucosal tumor with marked mucosal edema (arrowhead).

Fig. 3

Endoscopic ultrasonography reveals a tumor with complex low and high echogenicity located in the submucosal and muscle layers (third to fourth layers).

Fig. 4

Resected gastric wall with omental tissue. The mucosa is markedly edematous. A central indentation is evident on the submucosal tumor (arrowhead).

Fig. 5

Histologic features of the gastric submucosal tumor stained with HE (low-power field). Pancreatic acinar cells, ducts, and islets of Langerhans are visible in the gastric submucosa.