Heterotopic Pancreas in the Gallbladder: Case Report and Literature Review

Abstract

Introduction. Heterotopic pancreas (HP) is the congenital presence of pancreatic tissue outside its normal location in the absence of vascular and anatomical connection with the main pancreas. HP can affect any part of the gastrointestinal tract, and it is mostly encountered in the stomach. The gallbladder is a rare site of HP, and our literature review revealed that only 38 cases were reported. We present a case of HP in the gallbladder that was presented with a picture of acute cholecystitis. After the case presentation, we will discuss HP in the gallbladder by reviewing the literature. Case Presentation. A 49-year-old male presented to the emergency department complaining of progressively worsening right upper abdominal pain for the last 24 hours. After thorough history and physical examination, a provisional diagnosis of acute cholecystitis was made. Abdominal ultrasonography revealed a rim of edema surrounding the gallbladder wall with two stones impacted at the gallbladder neck. Laparoscopic cholecystectomy was performed with an uneventful postoperative course, and the patient was discharged the next day. Microscopic examination of the gallbladder showed that a heterotopic pancreatic tissue, composed of a large number of pancreatic acini and few ducts with the absence of islets of Langerhans, was found around the cystic duct. The patient was asymptomatic at the regular follow-up six months postoperatively. Conclusion. HP in the gallbladder is an extremely rare finding. Its clinical presentation is not different from other cholecystopathic diseases. Most cases were accompanied by cholelithiasis. Preoperative laboratory and imaging modalities are usually not helpful in the diagnosis of HP in the gallbladder. The definitive diagnosis is made by histological examination of the gallbladder specimen. Laparoscopic cholecystectomy is sufficing treatment.

The rare entity of ectopic pancreatic tissue in the gallbladder: A case report

“…Although, the male-to-female ratio of any type of EPT is 3:1, specifically for EPT in the gallbladder region, there is a female predominance, probably due to more cholecystectomies among women [ 8 , 9 ]. The median age of the reported cases was 46, with most patients being more than 40, contrary to our case, while chololithiasis coexisted with EPT in half of them.…”

“…The median age of the reported cases was 46, with most patients being more than 40, contrary to our case, while chololithiasis coexisted with EPT in half of them. Less than 40 cases of EPT in gallbladder have already been reported in the literature [ 9 ]. In almost all the cases, EPT in the gallbladder is diagnosed, after the resection and the histopathologic examination of the gallbladder.…”

A case report of ectopic pancreatic tissue in the gallbladder

“…The developing pancreases has areas of tissue that become separated from the main body of the pancreas [ 1 , 5 ]. In the literature <40 cases have been described [ 6 ]. Jean Schultz first described heterotropic pancreas in the 18th century, however, the first classification was made by Heinrich et al .…”

Heterotopic pancreatic tissue on the gallbladder wall: An incidental finding at laparoscopic appendectomy

“…More rarely ectopic pancreas tissue can be found in other locations including the gallbladder and lungs [4]. In a systematic review published in 2021, Aborajooh et al reported a total of 38 cases from 1959 to 2020 of heterotopic pancreatic tissue in the gallbladder, representing approximately 1-2% of all cases of heterotopic pancreas [5]. Most cases were incidental diagnosis during cholecystectomies for symptomatic gallstone disease leading to an increased finding in women and an age above 40 [4,5].…”

“…In a systematic review published in 2021, Aborajooh et al reported a total of 38 cases from 1959 to 2020 of heterotopic pancreatic tissue in the gallbladder, representing approximately 1-2% of all cases of heterotopic pancreas [5]. Most cases were incidental diagnosis during cholecystectomies for symptomatic gallstone disease leading to an increased finding in women and an age above 40 [4,5]. In approximately 10% of cases the tissue was thought to resemble gallbladder polyps or malignancy on imaging, often found as a submucosal lesion up to 3 cm with an endoluminal growth pattern, which formed the indication for surgery [2,5].…”