Pancreatic rest disguised as inflammatory bowel disease in young adult

Abstract

Pancreatic rest, otherwise known as aberrant, ectopic or heterotopic pancreas, occurs when the pancreatic tissue does not have an anatomical or vascular connection to the normal body of the pancreas. This rare congenital anomaly was first described in 1727 by Hunt and Bonesteel, and it is now known to be found predominantly within the stomach or proximal small bowel. Most of the time, pancreatic rest is asymptomatic and is found incidentally. When symptomatic, the most common presentations tend to be: abdominal pain, nausea, gastrointestinal bleeding, obstruction and symptoms of pancreatitis. We report a case of a 21-year-old female with symptomatic pancreatic rest noted in two locations: antrum of the stomach and the proximal jejunum just distal to the ligament of Treitz.

Keywords: aberrant pancreas; ectopic pancreas; inflammatory bowel disease; pancreatic rest.

Figure 1

Robotic intraoperative view of identified lesion; the intraabdominal lesion was easily identified (white outlined arrow) immediately adjacent to the previously placed endoscopic tattoo (solid white arrow).

Figure 2

Gross and pathologic representation of resected pancreatic rest; the resected portion of jejunum was opened to reveal an intraluminal mass (solid black arrow); the mass underwent further pathologic evaluation, which revealed acini, ducts (outlined white arrow) and Islet cells (solid white arrow) specific to the pancreas and confirming the diagnosis of pancreatic rest.