Intussusception Secondary to Isolated Heterotopic Pancreas of the Ileum: Case Report and Review of the Literature

Abstract

A Jacobz, A Nawaz, H Matta, A Al Salem, Intussusception Secondary to Isolated Heterotopic Pancreas of the Ileum: Case Report and Review of the Literature. 2002; 22(3-4): [213][214][215] Intussusception in the pediatric age group is usually idiopathic in origin, and in a small number of patients ranging from 2% to 12%, a pathological lesion as a leading point is identifiable. [1][2][3][4] Of the variety of pathologcial lesions identified as leading points for intussusception, Meckel's diverticulum is the most common, and very rarely, isolated heterotopic pancreas of the ileum.5 This is a case report of intussusception in an infant caused by an isolated heterotopic pancreas of the ileum. The literature on the subject is also reviewed. Case ReportAn 11-month-old male infant was admitted to the hospital because of abdominal pain, fever and vomiting of two hours' duration. The infant had had diarrhea the day prior to admission, and while in hospital, he had passed one bloody stool. Clinically, he was mildly dehydrated, and no masses could be felt on abdominal examination. The possibility of intussuscpetion was raised, and this was confirmed by an abdominal ultrasound. A contrast enema revealed intussusception as far as the splenic flexure, and was partially reduced under fluroscopic control.The patient had a laparotomy through a transverse, muscle-splitting incision in the right iliac fossa. The intussusception was reduced manually, and while examining the small intestine, a small polyp was found in the distal ileum. This was excised via a small enterotomy, which was closed transversely. Postoperatively, the patient did well and was discharged home on the sixth postoperative day. Histology of the resected polyp (Figures 1 and 2) revealed a 1 cm polypoid tissue covered with a flat, severely inflamed and ulcerated intestinal mucosa. In the underlying stroma were abundant glandular ductal structures resembling those in the pancreas and surrounded by slightly irregular thin-walled blood vessels. Among the glandular structures were streaks of smooth muscle tissue as well as lymphatic hyperplasia at the margins.

Isolated ileal heterotopic pancreas in a child: A clinically undetected cause of ileoileal intussusception

“…Submucosal and muscular wall proximity of the pancreatic tissue is hypothesized to aggravate bowel dysmotility and act as local disturbance leading to intussusception [12,13]. This is confirmed by the previous reports in literature where most of the cases of intussusception due to isolated pancreatic heterotopia in the ileum were either submucosal or serosal [4,6]. In our patient also, isolated heterotopic pancreas in the submucosa of ileum acted as the lead point of ileoileal intussusception.…”

“…The relative frequency of a pathological lesion causing intussusception increases with age. However, the highest frequency of detection of pathologic lesion in cases of intussusception is still the first year of life [6], as in the present case. In a review of 10 children with ileoileal intussusception due to heterotopic pancreas, seven patients were less than two years of age and of these, four were infants [6].…”

“…The incidence of a pathologic process as the leading point of intussusception varied from 2-12% in the previous studies in literature [6]. The various pathologic lesions identified as leading points in pediatric intussusception include Meckel's diverticulum (most common) followed by intestinal polyps, duplication cysts and lymphoma [7, manual reduction [6]. Hence, it is imperative to palpate for lesions like heterotopic pancreas within the wall of ileum after manual reduction [6].…”

“…On an extensive review of the existing English literature, we found less than 25 cases of isolated heterotopic pancreas of ileum as leading point for intussusception in pediatric age group [2,4,6]. The relative frequency of a pathological lesion causing intussusception increases with age.…”

“…Lesions of heterotopic pancreas measuring >15 mm in diameter and lying close to the mucosa are most likely to be symptomatic. In rare instances, isolated heterotopic pancreatic tissue in the ileum acts as a leading point for intussusception [1,4,6,11]. Submucosal and muscular wall proximity of the pancreatic tissue is hypothesized to aggravate bowel dysmotility and act as local disturbance leading to intussusception [12,13].…”