Heterotopic Pancreas in the Common Bile Duct, with a Review of the Literature

Sumiyoshi, Tatsuaki; Shima, Yasuo; Okabayashi, Takehiro; Kohsaki, Takuhiro; Kigi, Atsushi; Iwata, Jun; Kozuki, Amane; Tokumaru, Teppei; Nishimori, Isao; Morita, Sojiro

doi:10.2169/internalmedicine.53.3007

Cited by 12 publications

(6 citation statements)

References 3 publications

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“…Approximately 29 cases have been reported in the gallbladder, comprising 1% of all heterotopic pancreas (24,25). Biliary lesions are even less common, with seven reported cases of heterotopic pancreas in the common bile duct and eight reported cases of intrahe-patic heterotopic pancreas (26,27). Middle-aged women are the most commonly affected and rarely have symptoms (24).…”

Section: Hepatobiliary Systemmentioning

confidence: 99%

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Heterotopic Pancreas: Histopathologic Features, Imaging Findings, and Complications

et al. 2017

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Heterotopic pancreas is a congenital anomaly in which pancreatic tissue is anatomically separate from the main gland. The most common locations of this displacement include the upper gastrointestinal tract-specifically, the stomach, duodenum, and proximal jejunum. Less common sites are the esophagus, ileum, Meckel diverticulum, biliary tree, mesentery, and spleen. Uncomplicated heterotopic pancreas is typically asymptomatic, with the lesion being discovered incidentally during an unrelated surgery, during an imaging examination, or at autopsy. The most common computed tomographic appearance of heterotopic pancreas is that of a small oval intramural mass with microlobulated margins and an endoluminal growth pattern. The attenuation and enhancement characteristics of these lesions parallel their histologic composition. Acinus-dominant lesions demonstrate avid homogeneous enhancement after intravenous contrast material administration, whereas duct-dominant lesions are hypovascular and heterogeneous. At magnetic resonance imaging, the heterotopic pancreas is isointense to the orthotopic pancreas, with characteristic T1 hyperintensity and early avid enhancement after intravenous gadolinium-based contrast material administration. Heterotopic pancreatic tissue has a rudimentary ductal system in which an orifice is sometimes visible at imaging as a central umbilication of the lesion. Complications of heterotopic pancreas include pancreatitis, pseudocyst formation, malignant degeneration, gastrointestinal bleeding, bowel obstruction, and intussusception. Certain complications may be erroneously diagnosed as malignancy. Paraduodenal pancreatitis is thought to be due to cystic degeneration of heterotopic pancreatic tissue in the medial wall of the duodenum. Recognizing the characteristic imaging features of heterotopic pancreas aids in differentiating it from cancer and thus in avoiding unnecessary surgery. RSNA, 2017.

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Section: Hepatobiliary Systemmentioning

confidence: 99%

“…Middle-aged women are the most commonly affected and rarely have symptoms (24). Rarely, the heterotopic tissue may cause obstruction that results in gallbladder hydrops, cholecystitis, gallbladder perforation, or biliary duct dilatation (26).…”

Section: Hepatobiliary Systemmentioning

confidence: 99%

Heterotopic Pancreas: Histopathologic Features, Imaging Findings, and Complications

et al. 2017

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“…GHP in the hepatobiliary system tract is rare and rarely symptomatic [ 15 ], but it occasionally causes bile duct dilatation, bile duct obstruction, gallbladder effusion, cholecystitis, and even gallbladder perforation, which may be related to its heterotopic location. And its complications are not significantly distinct from other hepatobiliary systematic lesions [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis

et al. 2021

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Heterotopic pancreas (HP) is an uncommon congenital abnormality in the developmental process of the pancreas, with gastrointestinal heterotopic pancreas (GHP) being the most common HP. The clinical manifestations of GHP may have variable patterns of presentation, dictated by both the anatomic location and the functional ability of the lesion. The most common imaging modality in detecting GHP is computed tomography (CT), while gastrointestinal barium fluoroscopy, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are also applied. The density and enhancement patterns of GHP are consistent with histological classifications. GHP with a predominantly acinar tissue component manifests homogeneous and marked enhancement on CT images, whereas a predominantly ductal GHP presents heterogeneous and mild enhancement. On MRI, the appearance and signal intensity of GHP were paralleled to the normal pancreas on all sequences and were characterized by T1-weighted high signal and early marked enhancement. This article provides a comprehensive review of the histopathology, clinical manifestations, imaging features of various modalities, and differential diagnosis of GHP. It is hoped that this review will improve clinicians’ knowledge of GHP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate.

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“…Jean Schultz described a case of pancreatic-gland-like tissue at the base of the ileal diverticulum in 1727, which is commonly believed to be the first case of ectopic pancreas recorded in literature. [13] The lesion has since been reported in various parts of the human body, but the true incidence of ectopic pancreas remains undetermined as most cases are asymptomatic. Existing data indicates a prevalence of 0.2% at laparotomy and 0.55% to 13.7% on autopsies as mentioned before.…”

Section: Discussionmentioning

confidence: 99%

Ectopic pancreas in the ileum

Xiang

Zhang

2019

Medicine

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Background: Ectopic pancreas in the ileum, including lesions within Meckel diverticulum, can cause severe manifestations and complications; yet, it was seldom reported in English literature.Aim: This study aimed to raise awareness and provide information for better clinical management of this rare yet serious condition.Methods: A total of 1713 cases of small bowel resection were performed in our hospital between 2009 and 2018, among which 10 cases of ileac ectopic pancreas were identified. A comprehensive retrospective review of the 10 cases was taken.Results: Five lesions were located in the ileum wall and 5 were within Meckel diverticulum. Two lesions within Meckel diverticulum were incidental; the remaining 8 lesions were all associated with abdominal pain, gastrointestinal bleeding, and anemia. Of the 5 patients with lesions in the ileum wall, computed tomography uniformly revealed ileoileal intussusceptions with masses as lead points. Capsule endoscopies were performed in 6 cases, of which 3 showed positive findings. Double-balloon enteroscopy was conducted in one case and revealed an ileal diverticulum. Therapeutically, the offending bowel segments were removed, and intussusceptions were restored except for one case in which diverticulectomy was applied. No relapse or sequela was observed in the follow-up.Conclusions: Ileac ectopic pancreas can be seen in the ileum wall or Meckel diverticulum. The majority of the lesions found in clinical practice present with abdominal pain, gastrointestinal bleeding, and anemia. Lesions in the ileum wall often cause ileoileal intussusception. Computed tomography, capsule endoscopy, and double-balloon enteroscopy are helpful preoperative examinations. Segmental small bowel resection is the treatment of choice.

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Heterotopic Pancreas in the Common Bile Duct, with a Review of the Literature

Cited by 12 publications

References 3 publications

Heterotopic Pancreas: Histopathologic Features, Imaging Findings, and Complications

Heterotopic Pancreas: Histopathologic Features, Imaging Findings, and Complications

Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis

Ectopic pancreas in the ileum

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