A case report of ectopic pancreatitis in an isolated enteric duplication cyst

Abstract

Background: Isolated enteric duplication cyst is an intestinal duplication cyst found in a distant location from the intestinal tract and it is said to have its own blood supply. Meckel's diverticulm is considered as an antimesenteric structure and has its own blood supply. However, there are some reported cases of Meckele's diverticum in the mesenteric side. Ectopic pancreas may be found in both entities.

Case presentation: A 5-year-old girl presented with increasing abdominal pain around the umbilicus. On laboratory investigation serum pancreatic enzymes and C-reactive protein were elevated. Abdominal computed tomography (CT) revealed a normal pancreas but a cystic lesion in the mesentery of the ileum. A nodule with a marked enhancement was observed in the wall of the lesion. During the laparoscopy, the lesion was found at the root of the mesentery and was distant from the ileum. The lesion was resected suspecting an abscess. Pathologically, the wall of the lesion consisted of small bowel like tissue, and pancreatic tissue was seen beneath the mucosa. There were some post inflammatory changes in the pancreatic tissue. Retrospectively on thin slice enhanced CT, an independent blood supply was noted. Based on these findings, a diagnosis of ectopic pancreatitis in an iliac intestinal duplication cyst was made.

Conclusion: Isolated enteric duplication cyst in the root of ileal mesentery and mesenteric Meckel's diverticulum have similarities. In the present case, the diagnosis of isolated enteric duplication cyst was made since it was found distant from the ileum. It is important to consider the possibility of ectopic pancreatitis when serum pancreatic enzymes are elevated even when the pancreas appears normal.

Keywords: Ectopic pancreas; Isolated enteric duplication cyst; Mesenteric Meckel’s diverticulum.

Fig. 1

Enhanced CT. a In the ileal mesentery at the level of the umbilicus, a cystic lesion with enhancing wall is seen (arrows). There is a enhancing nodule in the cystic wall (arrow heads). b On coronal plane, the lesion appears to be a tubular structure. The fat density around the lesion is increased suggesting inflammation (arrows)

Fig. 2

Enhanced CT, retrospective finding. An independent blood vessel coursing through the dorsal side into the lesion was identified (arrows)

Fig. 3

Follow-up CT. On the follow up CT at 3 months revealed, decrease in size of the lesion is seen. There is a enhancing nodule seen in the cystic wall (arrow)

Fig. 4

Pathological findings. a Gross appearance of the resected lesion. b On loupe image, the cystic wall was composed of small intestine wall with villi in the mucosa. Ectopic pancreatic lobules are seen in the cystic wall. c On high power view, acini, islets of Langerhans and pancreatic ducts are seen in the pancreatic tissue. d Lymphocytes infiltration and acinar loss with islet-cell pseudohyperplasia (arrows), which are evidence of post pancreatitis, are observed