Heterotopic Pancreas: Unusual Cause of Usual Diarrhoea

Abstract

Heterotopic pancreas (HP) also known as ectopic pancreas, pancreatic crest or accessory pancreas is the normal pancreatic tissue, found in a remote area other than its natural location, with no anatomic or vascular connection to main pancreatic tissue. It is a rare congenital anomaly and has been reported at many locations such as stomach (antrum) and small intestine. HP is usually an incidental finding and asymptomatic, however there are reports of pancreatitis, obstruction, perforation and malignant transformation as uncommon manifestations. Diagnosis of HP is primarily based on histological examination either by biopsy or surgical excision. Surgery is the standard treatment for symptomatic HP patients. Herein, we present a case of a 58-year-old female, who presented to us with intractable diarrhoea due to HP in the jejunum and underwent minimally invasive surgery for definitive diagnosis and treatment.

Keywords: Accessory pancreas; Ectopic pancreas; Heterotopic pancreas; Pancreatic crest; Pancreatic heterotopia.

Fig. 1

A Contrast enhanced computed tomography scan image showing enhancing lesion in the proximal jejunum, B nodular deposit in proximal jejunum intraoperatively, C resected specimen of jejunal segment

Fig. 2

A, B Microscopic H & E images showing presence of normal pancreatic tissue, ducts, islets cells and acini in small intestinal wall (overlying small intestinal mucosa seen)