BACKGROUND: Heterotopic pancreas is defined as pancreatic tissue located outside the pancreatic parenchyma that lacks an anatomic or vascular connection to the normal pancreas. Symptomatic gastric heterotopic pancreas is a rare condition that can manifest as acute or chronic pancreatitis. Asymptomatic heterotopic pancreas does not require treatment, while symptomatic lesions should be resected. The modality of final resection of heterotopic pancreas depends on its size and the depth of gastric wall involvement. METHODS AND RESULTS: A 36-year-old woman was admitted for recurrent epigastralgia. Abdominal computed tomography (CT) scan revealed that an abscess had formed in the gastric antrum. After multidisciplinary discussion we decided for conservative treatment with intravenous antibiotics and further detailed endoscopic diagnostic. Esophagogastroduodenoscopy revealed a submucosal mass with a central fistula and intermittent pus secretion in the prepyloric region of the gastric antrum, which was subsequently drained with a double pigtail stent under endoscopic ultrasound (EUS) and fluoroscopy. The possibility of pancreatic fluid collection in the case of heterotopic pancreas was suggested during the EUS examination, and histology subsequently confirmed heterotopic pancreatic tissue. The patient was in good condition and without any abdominal pain. According to a control CT scan after 10 weeks, the fluid collection was completely resolved. Due to the possible recurrence of pancreatitis, resection of heterotopic pancreas was proposed to the patient. Since the lesion involved the muscularis propria of the gastric wall, surgical resection of the mass was indicated. CONCLUSION: Fluid collections after acute pancreatitis in heterotopic pancreas in the gastric antrum can be successfully managed by endoscopy.

Department of Internal Medicine Beskydy Gastrocentre Hospital Frydek Mistek El Krasnohorske 321 73801 Frydek Mistek Czech Republic

Department of Internal Studies Faculty of Medicine University of Ostrava Czech Republic

Department of Pathology Hospital Frydek Mistek El Krasnohorske 321 73801 Frydek Mistek Czech Republic

Department of Radiodiagnostic Hospital Frydek Mistek El Krasnohorske 321 73801 Frydek Mistek Czech Republic

Department of Surgery Hospital Frydek Mistek El Krasnohorske 321 73801 Frydek Mistek Czech Republic

Zobrazit více v PubMed

Slidell MB, Schmidt EF, Jha RC, Rossi CT, Becker TE, Guzzetta PC. Solid pseudopapillary tumor in a pancreatic rest of the jejunum. J Pediatr Surg 2009;44:E25-27. doi: 10.1016/j.jpedsurg.2009.01.074 PubMed DOI

Yamaoka Y, Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Numata M, Sugimoto S, Imai K, Hotta K, Sasaki K. Adenocarcinoma arising from jejunal ectopic pancreas mimicking peritoneal metastasis from colon cancer: a case report and literature review. Surg Case Rep 2015;1:114. doi: 10.1186/s40792-015-0118-1 PubMed DOI

Ginori A, Vassallo L, Butorano MA, Bettarini F, Di Mare G, Marrelli D. Pancreatic adenocarcinoma in duodenal ectopic pancreas: a case report and review of the literature. Pathologica 2013;105:56-8.

Trifan A, Tarcoveanu E, Danciu M, Hutanasu C, Cojocariu C, Stanciu C. Gastric heterotopic pancreas: an unusual case and review of the literature. J Gastrointestin Liver Dis 2012;21:209-12.

Lucena JF, Alvarez OA, Gross GW. Endoscopic resection of heterotopic pancreas of the minor duodenal papilla: case report and review of the literature. Gastrointest Endosc 1997;46:69-72. doi: 10.1016/s0016-5107(97)70214-1 PubMed DOI

Krinsky M, Binmoeller K. Endoscopic ultrasound for the characterization of subepithelial lesions of the upper gastrointestinal tract. www.uptodate.com 2021.

Trandafir LM, Aprodu SG, Mihaila D, Anton Paduraru DT, Butnariu L, Straticiuc Ciongradi IC. Ectopic jejunal pancreas and congenital duodenal stenosis in a newborn patient: an unusual association. Rom J Morphol Embryol 2014;55:707-10.

Sarsenov D, Tirnaksiz MB, Dogrul AB, Tanas O, Gedikoglu G, Abbasoglu O. Heterotopic pancreatic pseudocyst radiologically mimicking gastrointestinal stromal tumor. Int Surg 2015; 100:486-89. doi: 10.9738/INTSURG-D-13-00242.1 PubMed DOI

Elfving G, Hastbacka J. Pancreatic heterotopia and its clinical importance. Acta Chir Scand 1965;130:593-602.

Christodoulidis G, Zacharoulis D, Barbanis S, Katsogridakis E, Hatzitheofilou K. Heterotopic pancreas in the stomach: a case report and literature review. World J Gastroenterol 2007;13:6098-100. doi: 10.3748/wjg.v13.45.6098 PubMed DOI

Gaspar Fuentes A, Campos Tarrech JM, Fernandez Burgui JL, Castells Tejon E, Ruiz Rossello J, Gomez Perez J, Armengol Miro J. Pancreatic ectopias. Rev Esp Enferm Apar Dig 1973;39:255-68.

Mulholland KC, Wallace WD, Epanomeritakis E, Hall SR. Pseudocyst formation in gastric ectopic pancreas. JOP 2004;5:498-501.

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11. doi: 10.1136/gutjnl-2012-302779 PubMed DOI

Gong EJ, Kim DH, Cho CJ, Lee SS, Jung HY, Yoo SH. Endoscopic submucosal dissection of ectopic pancreas with pancreatitis and pseudocyst formation. Gastrointest Endosc 2015;82:1126. doi: 10.1016/j.gie.2015.06.029 PubMed DOI

Noh JH, Kim DH, Kim SW, Park YS, Na HK, Ahn JY, Jung KW, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY. Endoscopic submucosal dissection as alternative to surgery for complicated gastric heterotopic pancreas. World J Clin Cases 2020;8:4708-18. doi: 10.12998/wjcc.v8.i20.4708 PubMed DOI