Incidental Duodenal Pancreatic Heterotopia During Laparoscopic Sleeve Gastrectomy: A Case Report and Literature Review

Abstract

Patient: Male, 15 Final Diagnosis: Duodenal pancreatic heterotopia Symptoms: None Medication: — Clinical Procedure: Wedge resection and primary repair Specialty: Surgery Objective: Congenital defects/diseases Background: Heterotopic pancreas is pancreatic tissue that presents outside the normal anatomical location. It is mostly discovered in the upper gastrointestinal tract (mostly the foregut). We report the first case report of incidentaloma of duodenal heterotopic pancreas in obese patients during laparoscopic sleeve gastrectomy. Case Report: A 15-year-old Saudi male obese patient was admitted electively for laparoscopic sleeve gastrectomy. Incidentally, during intraoperative procedure, a duodenal nodule was noted in the first part of the duodenum. A wedge re-section of the mass was done after a standard laparoscopic sleeve gastrectomy was accomplished and it had an uneventful postoperative course. The histopathological examination showed heterotopic pancreas tissue. Conclusions: Gastrointestinal stromal tumors are found to be the most common incidental pathology during bariatric surgery. The safety and efficacy of excision of similar lesions during laparoscopic sleeve gastrectomy needs to be further investigated.

Ectopic pancreas in a 16-year-old male during bariatric surgery: A rare case in the medical literature

“…There are four different morpho-pathological types of EP: type 1 consists of complete pancreatic tissue, type 2 contains only pancreatic ducts, type 3 includes solely acinar tissue, and type 4 comprises only islet cells [ 14 ]. While all cases have ductal and acinar cell pancreatic components, only one-third of cases, including ours, have Islets of Langerhans identified [ 15 ]. It is crucial to evaluate bariatric patients before surgery.…”

“…As bariatric surgery is becoming more popular, there have been more reports of unexpected findings during the procedure [ 2 ]. In asymptomatic young patients with EP incidentaloma, local excision is the preferred surgical treatment as it can become symptomatic or malignant [ 15 ]. During laparoscopic bariatric surgery, the majority of unexpected pathological lesions encountered can be removed without elevating the risk of postoperative complications.…”

“…We present a rare case of EP in the proximal jejunum of a 16-year-old male, which is found incidentally during a bariatric surgery. To the best of our knowledge, this is the first documented case of incidentally detected heterotopic pancreatic tissue in jejunum during a bariatric procedure in Syria, and it is also the fourth case in the medical literature [ [17] , [18] , [19] ]. The work has been reported in line with the SCARE criteria [ 20 ].…”

Pancreatic morphological abnormality that was challenging to differentiate from an ectopic pancreas: a case report

“…Still, surgery is considered for symptomatic patients. A definitive diagnosis cannot be made, and it is necessary to differentiate between gastrointestinal stromal tumor, cancer, insulinoma, and cases in which there is a tendency for the ectopic pancreas to increase in size [ 15 ]. In this case, the indication for surgery was appropriate owing to the mild but recurring pancreatitis.…”