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.

• Klíčová slova
• drainage, endoscopy, heterotopic pancreas, pancreatitis, surgery,
• MeSH
• akutní nemoc MeSH
• dospělí MeSH
• endoskopie MeSH
• endosonografie MeSH
• lidé MeSH
• pankreas MeSH
• pankreatitida * chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Heterotopic pancreas is a congenital pathology of the gastrointestinal tract, particularly rare in the esophagus. Both symptomatology and findings during preoperative examinations are non-specific and therefore do not often lead to an accurate diagnosis, which is usually revealed only by histopathological assessment of a resected specimen. We report an unusual case of a patient suffering from severe dysphagia caused by heterotopic pancreas in the distal esophagus with chronic inflammation and foci of premalignant changes. This article also reviews 14 adult cases of heterotopic pancreas in the esophagus previously reported in the literature, with the aim of determining the clinical features of this disease and possible complications including rare premalignant lesions and malignant transformation. Especially with regard to those complications, we suggest that both symptomatic and incidentally found asymptomatic lesions should be resected.

• MeSH
• biopsie MeSH
• choristom diagnóza   chirurgie   MeSH
• dospělí MeSH
• ezofagektomie MeSH
• lidé MeSH
• multimodální zobrazování metody   MeSH
• nádory jícnu diagnóza   chirurgie   MeSH
• nádory slinivky břišní * MeSH
• pankreas MeSH
• počítačová rentgenová tomografie MeSH
• pozitronová emisní tomografie MeSH
• prediktivní hodnota testů MeSH
• prekancerózy diagnóza   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

Heterotopic pancreas (HP) is defraed as abnormally localized pancreatic tissue without any anatomical and vascular connection with pancreas. Incidence of HP is 0.2-0.5% of patients underwent upper medial laparotomy. The most common symptoms of HP are abdominal discomfort and pain, upper gastrointestinal bleeding and intermittent bowel obstruction. Gastroscopy is the most commonly used first diagnostic procedure. Ultrasound evaluation, computer tomography and namely endoscopic ultrasound evaluation are useful imaging procedures of HP. Casuistic report of patient with upper gastrointestinal bleeding is presented. Imaging procedures have recorded stomach tumor 3cm in diameter in back wall of stomach. Billroth II resection of stomach was performed. Histological evaluation of removed part of stomach recorded heterotopic pancreas type 1 of Heinrich classification. HP diagnosis before surgery is difficult because of submucous localization of lesion. Fine needle biopsy during gastroscopy is one of diagnostic possibilities without surgery. Endoscopic excision of lesion is possible if histological evaluation by fine needle biopsy is successful and anatomical localization is appropriate. The most of patients need surgical excision of HP. Peroperative histological evaluation allows a minimalization of excision area. Opinions of asymptomatic HP treatment are ambiguous. The most of published papers recommend excision of asymptomatic HP also, because of risk of next complications.

• MeSH
• choristom diagnóza   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci žaludku diagnóza   chirurgie   MeSH
• pankreas * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

A 48-year-old woman with complaints referable to the biliary tract was treated by cholecystectomy. Morphological examination revealed a focus of the heterotopic pancreatic tissue (7 x 4 x 3 mm) situated within the gallbladder body wall. Microscopically, all the normal structures were found, i.e., secretory acini, ducts and scattered endocrine cells.

• MeSH
• choristom patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci žlučníku patologie   MeSH
• pankreas * MeSH
• žlučník patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Perfluorohexyloctane (PFH) is a promising storage solution that has been successfully used for pancreas preservation before islet isolation. This hyperoxygen carrier has been designed to prevent ischemic injury to the pancreas graft during cold storage. In our storage, we aimed to evaluate the impact of this solution on long-term cold storage in a rat whole pancreas transplantation model. METHOD: Brown-Norway rats were used for syngeneic heterotopic pancreas transplantation. The procured organs were cold-stored for 18 hours in preoxygenated PFH (PFH group; n = 8) or in the University of Wisconsin solution (UW group; n = 8), or were transplanted immediately in the control group (n = 8). Two hours after reperfusion, we obtained blood and pancreas tissue samples for biochemistry and gene analyses (real-time polymerase chain reaction). RESULTS: A significant difference between the UW and PFH group was observed in the tumor necrosis factor (TNF)β and endothelin 1 genes, which was overexpressed more than twofold in the UW group. In the blood samples, the UW group compared with the PFH group showed significantly higher levels of pancreatic amylase and lipase (94.2 ± 25.2 vs 67.7 ± 13.4 μkat/L and 5.5 ± 2.8 vs 3 ± 0.7 μkat/L, respectively; P < .05). CONCLUSION: We found significantly lower expression levels of the endothelin 1 and TNFβ genes and lower concentrations of pancreatic amylase and lipase in the PFH group. All these findings suggest lower rate of ischemic reperfusion injury in the PFH group. These findings may result in better post-transplant outcomes after long-term cold storage in PFH compared with the UW solution. Further research in this area is required.

• MeSH
• biologické modely * MeSH
• endotelin-1 genetika   MeSH
• exprese genu * MeSH
• fluorokarbony * MeSH
• kryoprezervace * MeSH
• krysa rodu Rattus MeSH
• TNF-alfa genetika   MeSH
• transplantace slinivky břišní * MeSH
• uchovávání orgánů * MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• endotelin-1 MeSH
• fluorokarbony * MeSH
• perfluorohexyl-octan MeSH Prohlížeč
• TNF-alfa MeSH

• MeSH
• choristom * patologie   MeSH
• dospělí MeSH
• gastrointestinální nádory * MeSH
• jejunum patologie   MeSH
• králíci MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory duodena patologie   MeSH
• nádory žaludku patologie   MeSH
• pankreas * MeSH
• pitva MeSH
• psi MeSH
• střevní nádory patologie   MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• králíci MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• psi MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

The authors present the case-record of a patient after combined transplantation of the pancreas and kidney who developed a chronic duodenocutaneous fistula. The case was resolved by elimination of the duodenocystoanastomosis of the transplanted pancreas and by obliteration of the pancreatic duct of the graft by a polymer. One year after surgery the patient has no complaints and the function of both transplanted organs is satisfactory.

• MeSH
• dospělí MeSH
• heterotopická transplantace škodlivé účinky   MeSH
• kožní píštěl etiologie   terapie   MeSH
• lidé MeSH
• nemoci duodena etiologie   terapie   MeSH
• pankreatická píštěl etiologie   terapie   MeSH
• polymery aplikace a dávkování   MeSH
• střevní píštěle etiologie   terapie   MeSH
• transplantace ledvin MeSH
• transplantace slinivky břišní škodlivé účinky   MeSH
• vývody pankreatu MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• polymery MeSH

• MeSH
• choristom diagnóza   MeSH
• diferenciální diagnóza MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory duodena diagnóza   MeSH
• nádory žaludku diagnóza   MeSH
• pankreas * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

A large cystic formation in the liver of 43-years old woman was identified as pancreatic pseudocyst, using histologic examination during laparotomy. The pancreas was found quite normal without any relation to the pseudocyst. Therefore it seems to be acceptable such a pathogenetic reflection, that the pseudocyst developed as a result of pathologic changes in heterotopic pancreatic tissue (embryonic malformation). The pseudocyst was partly resected and the large cavity in the liver was drained into the small intestine using Roux loop. After 8 months uncomplicated follow-up of the patient, the CT picture of her liver was nearly normal.

• MeSH
• choristom komplikace   diagnóza   MeSH
• dospělí MeSH
• lidé MeSH
• nádory jater komplikace   diagnóza   MeSH
• pankreas * MeSH
• pankreatická pseudocysta komplikace   diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Accessory spleen is a relatively common congenital defect with a 10% incidence in the population. Intrapancreatic accessory spleens are rare and cystic formation may mimic a hypervascular pancreatic tumour. CASE REPORT: We present the case of a 27-year-old woman who underwent abdominal ultrasonography (USG) because of chronic abdominal discomfort. USG findings revealed a 20 mm cystic mass in the tail of the pancreas. Additional preoperative investigations showed a tumour in the tail of the pancreas suspected of being a non-active neuroendocrine tumour. The intraoperative finding was a hard mass in the tail of the pancreas and neither peritoneal dissemination nor metastasis was detected. Distal pancreatectomy was performed. Pathological examination described an epithelial cyst in an intrapancreatic accessory spleen. DISCUSSION: Cyst formation in an intrapancreatic accessory spleen is extremely rare. Most patients with this condition have no clinical symptoms and it is often detected incidentally by imaging studies. It is difficult to differentiate an epithelial splenic cyst in the pancreas from a primary pancreatic neoplasm because it lacks particular characteristics on radiological examination; epithelial splenic cysts should be considered in the differential diagnosis of a cystic lesion in the tail of the pancreas. Key words: spleen - epithelial cyst - intrapancreatic accessory spleen.

• MeSH
• choristom diagnóza   chirurgie   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• lidé MeSH
• nemoci slinivky břišní diagnóza   patologie   chirurgie   MeSH
• pankreas patologie   MeSH
• pankreatektomie MeSH
• pankreatická cysta diagnóza   patologie   chirurgie   MeSH
• slezina * patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH