Ectopic pancreatic tissue is most often an incidental finding of imaging, surgery, or autopsy. Image-guided diagnosis is difficult, and definitive diagnosis usually relies on histological analysis. A case of ectopic pancreatic tissue located near the lesser curvature of the stomach is presented followed by a brief discussion of the clinical management of heterotopic pancreas.
KeywordsHeterotopic pancreas; pancreatic rests.
Case reportA 37-year-old woman presented to the emergency room (ER) with moderate, colicky abdominal pain located in the left lower quadrant. The patient had a history significant for missed menstrual periods (last menstrual period reported 8 months ago) and a surgical history remarkable for a right oophorectomy due to menstrual associated pain. The patient was otherwise healthy and was without any other systemic illnesses.On presentation the patient denied fever, diarrhea, constipation, black stools, hematochezia, hematemesis, dysuria, or abnormal vaginal bleeding. On physical examination, vital signs were within normal limits. The abdomen was soft, non-distended, but mildly tender in the left lower quadrant inferiorly. No rigidity, rebound, or guarding was present.Comprehensive metabolic profile, amylase, lipase, and urinalysis were all within normal limits. Her white blood cell count was increased to 21,300/ml with a left shift. Her pregnancy test was negative. A computed tomography (CT) scan of her abdomen and pelvis was ordered, which revealed a left periadnexal mass and a 2-cm exophytic mass adjacent to the lesser curvature of the stomach and to the lateral segment of the left lobe of the liver. Ultrasonography confirmed the left periadnexal mass to be cystic. Her pain was thought to be due to the ovarian cyst. The patient improved with pain management and intravenous fluids; she was then discharged home with pain medication and referred to general surgery for consultation on the upper abdominal mass.This paper is available online at http://www.grandrounds-e-med.com. In the event of a change in the URL address, please use the DOI provided to locate the paper.