Heterotopic pancreas presenting as ileoileal intussusception

Abstract

Heterotopic, aberrant or ectopic pancreas is defined as the presence of pancreatic tissue in topographic anomaly, with no anatomical, neural or vascular connection to the normal pancreas. It is a rare condition found mainly in stomach, duodenum and jejunum. Ileal heterotopic pancreas is an uncommon condition and has been rarely reported in children so far. Hereby we report a case of heterotopic pancreas presenting as ileal poyp leading to ileoileal intussusception in a 12 year child.

Isolated Ileal Pancreatic Heterotopia Causing Intussusception with Gangrene

“…The median age of presentation is around 12 months (interquartile range of 6.5 to 41 months), with the youngest case being at 2 months. (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Most patients with ileal heterotopic pancreatic tissue, without Meckel's diverticulum are asymptomatic and usually tends to be revealed incidentally during surgery for other indications [5]. They may present with lower gastrointestinal bleeding, irritability or recurrent abdominal pain due to intussusception [6,7].…”

“…Gangrene occurred in more than 50% of cases, including both our patients as shown in Table 1. On examination, heterotopic pancreatic tissue may appear as a 1-5 mm yellowish nodule with mucosal covering, exhibiting a central hole representing the rudimentary pancreatic ducts [2]. Clinically significant lesions tend to be greater than 1.5 cm in diameter and adjacent to or directly involving the mucosa [19].…”

“…Heinrich classified heterotopic pancreatic tissue into three types [2]: type 1 containing acini, ducts and islets; type 2 containing few acini, multiple ducts, without endocrine elements; and type 3 showing ductal cells surrounded by smooth muscle cells, without exocrine and endocrine elements. The heterotopic tissue may be found within a polyp, as seen in our first case [2,5,8,9]. There may be associated heterotopic gastric tissue also [10,11].…”

“…In the gastrointestinal tract, ileal location is uncommon and is usually found in a Meckel's diverticulum [2]. Isolated ileal pancreatic heterotopia as a lead point of intussusception is extremely rare and we describe two such cases.…”

Feeding Intolerance and Vomiting Caused by Duodenal Pancreatic Heterotopia in a Neonate

“…Epigastric pain, tarry stool, abdominal fullness, dyspepsia, gastric ulcers, changes in bowel habit, obstructive jaundice, vomiting, weight loss, and gastrointestinal bleeding are reported in adults (3,4,6). Occasionally, it may cause invagination or intussusception (8,9). The heterotopic pancreatic tissue can undergo complications such as inflammation (acutechronic pancreatitis, and abscess), obstruction (gastric outletjejunal obstruction), pseudocyst formation and malignant transformation (7).…”