Emergency Presentation of Gastric Ectopic Pancreas

Abstract

Ectopic pancreas is a rare embryological abnormality apparently not in association with others. Stomach and duodenum are the most common organs involved. Symptoms are nonspecific. Patients may complain of dyspepsia, abdominal pain or intestinal obstruction. Malignant evolution of ectopic pancreatic cells has been reported. Diagnosis can be very challenging due to the rarity of the disease and the absence of specific symptoms and radiological findings. We report two cases of young-adult men admitted to the emergency department due to acute upper gastro-intestinal and pancreatic symptoms. In both cases, during upper gastrointestinal endoscopy no mucosal vegetations were found. Endoscopic ultrasonography revealed gastric lesions originating from the muscularis propria, with a pattern suspected but not conclusive for malignancy. Fine needle aspiration was inconclusive in both cases. The patients underwent abdominal computed tomography, that showed gastric masses originating from the antrum and the lesser curvature of the stomach, with enlarged locoregional lymph nodes. According to the patients’ symptoms, family history, radiological and cytological findings, the patients were scheduled for an explorative laparoscopy. In both cases, gastric ectopic pancreas was found. Clinical presentation of ectopic pancreas is heterogeneous and the diagnosis can be challenging, especially in an emergency setting. Endoscopic ultrasonography and fine needle aspiration can be useful for the diagnosis and clinical staging, but they can be unspecific. Diagnostic-therapeutic laparoscopy should be considered in symptomatic patients.

Ectopic pancreatic tissue in stomach: A case report

“…Notable is that clinical symptoms depend on the location and size of the lesion and especially if the lesion's size is more than 1,5 cm, clinical manifestations are more probable [ 13 ]. Rare conditions such as pancreatitis, pseudocyst, bleeding, or malignant transformation (adenocarcinoma) can occur in the lesion, like in the orthotopic pancreas, with malignancy emerging in only 0,7–1,9% of the cases [ 5 , 13 , 14 ]. Furthermore, owing to the anatomical position, gastric outlet obstruction, intussusceptions, obstructive jaundice, intestinal obstruction, or thoracic pain may arise [ 2 , 14 ].…”

“…Abnormalities that should be taken into consideration as a differential diagnosis are lymphoma, GIST, neuroendocrine tumors (NET) [ 8 , 11 ]. Typically, the finding during endoscopy is characterized by a firm round or oval subepithelial mass with normal mucosa and a central dimpling (35%–90%) with the outlet of a duct on its top, which, however, can be present in GIST and NET too [ 2 , 14 ]. Moreover, in EUS the lesion appears with heterogeneous echogenicity, mainly hypoechoic, and can be classified as M-type or S-type if the lesion occupies the muscularis propria or the submucosal and the mucosal layer [ 2 , 8 ].…”

Co-occurrence of ectopic pancreas and superior mesenteric artery syndrome in a child: A case report and literature review

“…Surgery can be a consideration for possible treatment in symptomatic patients and definitive diagnosis. 3 …”