A case of gastric heterotopic pancreas with gastroduodenal invagination

Abstract

Background Heterotopic pancreas (HP) is a rare disease commonly found incidentally on imaging studies, at endoscopy or at autopsy and can be associated with abdominal pain, vomiting, heart burn, gastric outlet obstruction, and even dysphagia in very rare cases. Heinrich’s classified HP into three groups, types1–3, with Heinrich’s type 3 HP the rarest and difficult to diagnose properly because it has only pancreatic ducts but has no islet and acini. The aim of this study is to report a case of gastric outlet obstruction caused by type 3 HP with gastroduodenal invagination with reference to the literature and diagnosed finally by immuno-histochemical analysis. Case presentation The case presented is a 40-year-old male presenting with vomiting and abdominal pain. Computed tomography (CT) revealed a cystic mass in the upper abdomen and he was referred to the Tokushima University. Gastric fiber showed that the pedunculated mass originated from the stomach. An open distal gastrectomy was performed. Pathologically, there was small glands proliferation in the sub-mucosal (SM) layer which was membrane and cytoplasm (MUC)1 positive and muscle proliferation. Results This finding revealed the tumor as HP. Postoperative course was uneventful and the patient was discharged 12 days after surgery. The patient has remained well 12 months after surgery. Conclusions HP should be considered in the differential diagnosis of SM tumors with gastroduodenal invagination even if this is a rare symptom.

Gastric outlet obstruction caused by heterotopic pancreas in a patient with alcohol use disorder

“…HP is often clinically silent, however may rarely become symptomatic. If located in the gastric antrum, in the setting of inflammation or enlargement of HP, GOO may occur ( Table 1 ) [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . HP can develop pancreatic adenocarcinoma as previously reported by other groups [11] .…”

Endoscopic Mucosal Resection of Pancreatic Rest Presenting as a Sub-epithelial Nodule in the Gastric Antrum

“…Although usually asymptomatic, the most commonly reported symptom is epigastric abdominal pain, occurring in as many as 75% of symptomatic cases. Reported complications of pancreatic rest in the stomach include acute or chronic pancreatitis, necrosis, pseudocyst, gastric outlet obstruction, and rarely carcinoma [6][7][8].…”