How Should the Pyloric Submucosal Mass Coexisting with Hypertrophic Pyloric Stenosis Be Treated?: A Case of Pyloric Ectopic Pancreas with Hypertrophic Pyloric Stenosis

Abstract

Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently.

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

“…In most cases, we noticed the presence of the EP within the GI tract, 31 , 33 – 37 and this does not negate the possibility of its presence outside it. 32 …”

“…Symptoms varied between irritation (bleeding, abrasions), 31 , 35 and obstruction, such as gastric outlet obstruction, 37 or even systemic hypoglycemia. 36 But abdominal pain remains the most common symptom, 37 , 38 The presence of the EP in our patient was in the stomach, and it caused abdominal pain, in the absence of any obstructive symptoms.…”

“…Multiple diagnostic methods helped to head for the diagnosis of the EP (like CT, ultrasound), but each time, we need a histological study to confirm the diagnosis. 31 – 38 .…”

Asymmetric Hypertrophic Pyloric Stenosis with Concurrent Pancreatic Rest Presenting as Gastric Outlet Obstruction

“…[4][5][6] Concurrent IHPS and heterotopic pancreas causing obstruction has been reported once previously. 7 In our patient, the initial pylorospasm may have resulted from local inflammation triggered by the heterotopic pancreas or attributable to measurements taken at different portions of the asymmetric pylorus. In infants with nonbilious emesis outside the expected age for IHPS or equivocal ultrasound findings, considerations should include an atypical presentation or less common etiologies.…”