Heterotopic pancreas in the gastrointestinal tract in children: a single-center experience and a review of the literature

Abstract

BackgroundHeterotopic pancreas, that is the abnormal localization of a well-differentiated pancreatic tissue, is a rare occurrence in pediatric patients. Most lesions are found incidentally; in some circumstances, the presence of heterotopic pancreas may cause gastrointestinal symptoms, such as obstructive symptoms or bleeding.Patients and methodsThe clinical notes of patients with histological diagnosis of heterotopic pancreas treated at Meyer Children’s Hospital between 2009 and 2017 have been retrospectively examined.Four variables have been examined: clinical presentation, age at diagnosis, timing of surgery and localization of the heterotopic pancreas. Patients have been classified accordingly.ResultsFourteen patients were diagnosed with heterotopic pancreas at a single institution. In half cases, heterotopic pancreas caused symptoms that warranted surgical exploration. Symptomatic patients were significantly older than patients in whom heterotopic pancreas was an incidental finding (mean age 9 years and 5 months vs 2 years and 9 months; p = 0.02). Heterotopic pancreas was more frequently found in patients who underwent urgent surgical procedure than in patients who underwent elective surgery (2.61% vs 0.22%; p < 0.0001). In all cases, foci of heterotopic pancreas were resected.ConclusionHeterotopic pancreas is usually discovered in the submucosa of the stomach, duodenum and small bowel. Heterotopic tissue may cause symptoms related to mechanical complications, bleeding from the surrounding intestinal mucosa or, occasionally, to the development of malignancy.Heterotopic tissue is a rare but clinically relevant cause of gastrointestinal symptoms. The presence of heterotopic tissue should be considered in children with gastrointestinal symptoms of unclear origin and surgical resection is advisable.

Pancreatic heterotopia: An overview of a lesion often mimicking neuroendocrine tumour

“…HP has been reported at all ages including children, average being 45 years. 5,[9][10][11] In our study, the age ranged from one day to 48 years (average 27.5 years). Dolan et al have reported the largest series of 214 cases of HP at Mayo clinic from 1952 to 1974.…”

Ectopia of the pancreas in the loop of the small intestine in an 8-y-o child

“…Литературные данные об эктопии поджелудочной железы свидетельствуют о редкости данного порока развития, что зачастую ведет к диагностическим и лечебно-тактическим ошибкам. Сложность диагностики и лечения ЭПЖ заключается в скудности и неспецифичности клинических проявлений заболевания [1][2][3][4].…”

“…В отсутствие осложнений ЭПЖ может длительное время протекать бессимптомно и выявляться лишь при диагностической лапароскопии или открытом оперативном вмешательстве по поводу другой патологии органов брюшной полости [9][10][11], аналогично представленному в данном наблюдении. Отсутствие специфических клинических проявлений, сложность диагностики в некоторых случаях становятся причиной позднего выявления порока развития, которое в дальнейшем выявляется у взрослых пациентов [4,12,13]. Диагностика ЭПЖ у детей на основании клинических и рентгенологических данных весьма сложна.…”

Gastrointestinal Tract Heterotopic Pancreas: Asymptomatic Pathology?

“…Patients’ age as a parameter for symptoms was reported by Persano et al [ 20 ]. In his study, which included 14 pediatric patients, seven patients (50%) were symptomatic and the rest were asymptomatic.…”