Localization and Laparoscopic Excision of Gastric Heterotopic Pancreas in a Child by Endoscopic SPOT® Tattooing

Abstract

Heterotopic pancreas (HP) is defined as pancreatic tissue lacking vascular or anatomic connection with the normal pancreas. Surgical resection is often indicated for symptomatic gastric HP. However, intraoperative identification of gastric HP is often difficult during laparoscopic surgery. Herein, we describe a patient with gastric HP, which was marked with SPOT® dye (GI Supply, Camp Hill, PA, USA). The dye was seen clearly laparoscopically facilitating total excision of the lesion. The final pathology report confirmed the presence of heterotopic pancreatic tissue including pancreatic acini, small pancreatic ducts tissue with islets of Langerhans in the deep gastric submucosal area. There were no postoperative complications, and the patient was symptom-free. To the best of our knowledge, this was the first case report in the literature in which endoscopic tattooing of gastric HP before laparoscopic resection was performed. This method of localization was simple and reliable in children.

Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study

“…Although over 86% of cases were treated with open surgery in this case series, minimal invasive approach should be considered as a treatment option in selected cases in the era of minimal access surgery [18,29]. What's more, EUS examination combined with extended biopsy or endoscopic SPOT ® Tattooing may help decide the type of procedure in submucosal gastric heterotopic pancreas [30][31][32][33]. In recent years, the characteristic imaging features and precise preoperative diagnosis may help differentiate heterotopic pancreas from malignancies, thus avoiding unnecessary extensive surgical intervention [6].…”

Clinical masks of pancreatic heterotopia: case report and systematic meta-analysis

“…(2) панкреатит (n = 260, 28%); 3) желудочно-кишечное кровотечение (n = 80, 9%); и (4) выходная обструкция желудка (n = 80, 9%). В большинстве случаев терапии ГПЖ (n = 832, 90%) была проведена хирургическая или эндоскопическая резекция, при этом 85% сообщили об исчезновении или улучшении симптомов [6].…”