Duodenal Pancreatic Heterotopy Diagnosed by Magnetic Resonance Cholangiopancreatography: Report of a Case

Abstract

We describe herein the case of a heterotopic pancreas that caused stenosis in the second portion of the duodenum. A 46-year-old man presented with upper abdominal pain and a 12-month history of intermittent vomiting. There was no history of melena, hematochezia, hematemesis, clay-colored stools, jaundice, or hepatitis and he did not describe any food dyscrasias, although fatty foods and alcohol seemed to make the symptoms worse. No specific medication or change in position relieved the pain. An initial diagnosis of chronic pancreatitis with multiple pseudocysts was made on the basis of elevated serum amylase and lipase levels, and abdominal ultrasonography and computed tomography (CT) findings. Medical treatment with octreotide was given for 8 weeks, but without any marked effect. Double-contrast barium examination and esophagogastroduodenoscopy were not diagnostic. Magnetic resonance (MR) cholangiopancreatography revealed findings indicative of cystic dystrophy of a heterotopic pancreas (CDHP), and an endoscopy supported this diagnosis. A pancreatoduodenectomy was performed and pathological examination confirmed a diagnosis of CDHP. In our opinion, MR cholangiopancreatography is the diagnostic tool of choice when CDHP is suspected.

Cystic Dystrophy in Heterotopic Pancreas of the Duodenal Wall

“…Unfortunately, endoscopic ultrasound was not available as a routine diagnostic procedure in our center prior to 2000, and this might be responsible for the weaker diagnostic yield prior to surgery. EUS with or without MRI is currently the procedure of choice when cystic dystrophy of the duodenal wall is in question [21,22,23,24,25,26]. CT, although seen by some authors as facilitating diagnosis of CDHP [21, 26], was inconclusive in our series and perhaps more misleading, as it suggested pancreatic neoplasia.…”

“…Ultrasonography can also assess the impact on biliary and pancreatic ducts. MRI can demonstrate the presence of cysts in the duodenal wall (a high-intensity signal on the T2 sequences) and interposition of a tissue between the duodenum and the head of the pancreas which appears as a low-intensity signal on all sequences [24]. …”

Duodenal heterotopic pancreas in a child

“…[2] Pancreatic heterotopy can be the site of tumor development from one of the cellular elements of heterotopy, or predispose to the formation of small cysts surrounded by infl ammation and scarring. [3] This phlogistic pattern of presentation is called the cystic dystrophy of heterotopic pancreas, which can be associated with chronic pancreatitis of the true pancreas. [3] However, duodenal heterotopic pancreas has been rarely reported in children so far.…”

“…[3] This phlogistic pattern of presentation is called the cystic dystrophy of heterotopic pancreas, which can be associated with chronic pancreatitis of the true pancreas. [3] However, duodenal heterotopic pancreas has been rarely reported in children so far. This report describes one case of duodenal heterotopic pancreas that caused chronic abdominal pain in a child.…”

Duodenal dystrophy: An interdisciplinary problem

“…ГППЖ -главный проток поджелудочной железы ДД -дуоденальная дистрофия ДПК -двенадцатиперстная кишка КТ -компьютерная томография МРТ -магнитно-резонансная томография ПДР -панкреатодуоденальная резекция ПЖ -поджелудочная железа УЗИ -ультразвуковое исследование ХП -хронический панкреатит ЭГДС -эзофагогастродуоденоскопия ЭУС -эндоскопическая ультрасонография грессирование эктопического панкреатита в вертикальной части ДПК может приводить к сдавливанию главного протока ПЖ (ГППЖ) и развитию обструктивного панкреатита в ортотопиче-ской железе [7,8]. В этом случае острый или ХП с преимуще-ственным поражением головки или ПЖ на всем протяжении рас-сматривается как осложнение ДД [9].…”