Acute Clinical Manifestation of Mesenteric Heterotopic Pancreatitis: A Pre- and Postoperative Confirmed Case

Abstract

Heterotopic pancreas is a relatively uncommon congenital anomaly, defined as pancreatic tissue in ectopic sites without an anatomic and vascular continuity with the main body of the pancreas. We report the case of a 58-year-old woman who was admitted to the hospital with the clinical suspicion of a mild, acute pancreatitis. Computed tomography, magnetic resonance imaging, transabdominal ultrasound, and endoscopic ultrasound revealed a normal orthotopic pancreas and the suspicion of a large heterotopic pancreas in the small bowel mesentery with signs of acute inflammation. The diagnosis of mesenteric heterotopic pancreatitis was preoperatively confirmed by endoscopic ultrasound-guided fine-needle aspiration and consequently histologically established after surgical resection.

The tale of 2 pancreases: Jejunal mesenteric ectopic pancreas causing recurrent ectopic pancreatitis

“…MRCP is particularly helpful in distinguishing EP from other entities, as it allows for easier detection of a pancreatic duct within the mass when present [13] . MEP differs in appearance from submucosal EP, as the majority of the mass in MEP is extraluminal, is more commonly elongated and more pancreatic in shape, and ductal communication with the bowel lumen is more often visible [5] . In comparison with submucosal EP, MEP has a more elongated body with a greater ratio of the long axis to short axis with a mean of around 3.0 [14] .…”

“…EP is most commonly found as a submucosal mass in the wall of the stomach, duodenum, or proximal jejunum but can occur elsewhere [2] . Mesenteric location of EP is quite rare with knowledge limited to a few case reports [3] , [4] , [5] . While most cases of EP are asymptomatic, they can present with complications, such as pancreatitis, bowel obstruction, gastrointestinal bleeding, or neoplasia.…”

Chronic pancreatitis of jejunal ectopic pancreas: a rare cause of chronic abdominal pain

“…One case has been reported of a 9-year-old in India with abdominal pain who underwent a bowel resection for a Meckel’s diverticulitis that contained inflamed ectopic pancreatic tissue [ 7 ]. Another case from the Netherlands reports a 58-year-old who presented with abdominal pain and was found to have EP within the jejunal mesentery [ 8 ]. Another case describes acute pancreatitis of EP within the gallbladder; this was also only diagnosed on post-operative histology [ 9 ].…”

Clinical characteristics of ectopic pancreas in digestive system

“…The pathogenesis of EP presumably attributes to the incorrect migration of ventral or dorsal pancreatic buds during embryonic development [2]. Previous studies reported that EP may locate within or outside the alimentary tract, including the most common sites stomach, duodenum, proximal jejunum, and some rare locations, such as liver, gallbladder, spleen, and mesentery [3][4][5]. Epigastric discomfort is the most common clinical symptoms of EP, while the specific symptoms are often vague.…”