Heterotopic pancreas causing duodenal obstruction in a patient previously treated for choledochal cyst

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Abstract

A 9-year-old boy presented with duodenal pancreatic rest causing obstruction and required surgical intervention. He had been treated at the age of 4 months for a choledochal cyst. Both choledochal cyst and heterotopic pancreas are entities that are commonly encountered in children, but the incidental presence of both the entities in the same child, albeit presenting metachronously, is extremely rare.

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Most cited references 18

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The clinical significance of heterotopic pancreas in the gastrointestinal tract.

C P Armstrong, P M King, J M Dixon … (1981)

A series of 34 histologically verified cases of pancreatic heterotopia in the records of the Department of Pathology at the University of Edinburgh between 1959 and 1979 has been analysed in order to determine the clinical significance of this unusual condition. In 13 patients (38 per cent) the heterotopic pancreatic tissue was symptomatic (i.e. the symptoms regressed completely on its removal). A correlation has been established between the presence of symptoms, the size of the lesion and the extent of mucosal involvement. Clinically significant lesions are greater than 1.5 cm in maximum diameter and are adjacent to or directly involve the mucosa.

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Heterotopic pancreas in the gastrointestinal tract.

Juan Tang, Jie Chen, Zhou Yuan … (2009)

Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 60-year-old man with carcinoid syndrome caused by heterotopic pancreatic tissue in the duodenum is described, along with a 62-year-old man with abdominal pain caused by heterotopic pancreatic tissue in the gastric antrum. The difficulty of making an accurate diagnosis is highlighted. The patients remain healthy and symptom-free after follow-up of 1 year. Frozen sections may help in deciding the extent of resection intraoperatively. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of gastrointestinal stromal tumor.

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Heterotopic pancreas in children: review of the literature and report of 12 cases.

Yukio Ogata, Minoru Yagi, H. Ishibashi … (2008)

Heterotopic pancreas (HP) is rarely recognized during surgery. Many reports concerning this anomaly are simple case reports. We herein review our experiences with HP. We retrospectively investigated cases of HP from April 1975 to September 2006. We discussed the frequencies in the laparotomized patients, and patient's age, gender, operative indication, location of HP, post-operative diagnosis and pathology. A total of 12 patients with HP, 3 boys and 9 girls, aged 1 day to 10 years of age were investigated. Ten patients had one pattern of HP and the remaining two had more than one. The locations of the HP were as follows: Meckel's diverticulum, 4; stomach, 3; duodenum, 3; jejunum, 3; and ileum, 2. Only in one patient HP had caused an intussusception. The remaining 11 cases were identified incidentally during the operation. In 11 of 12 patients, HP was removed without post-operative complications. Classification of pathologies according to Heinrich is as follows: type I, 4; type II, 4; type III, 2 and unknown, 2. Patients with HP are usually asymptomatic. However, HP caused an intussusception in our series. Incidental HPs should be removed whenever identified during laparotomy.

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Author and article information

Journal

Journal ID (nlm-ta): J Indian Assoc Pediatr Surg

Journal ID (publisher-id): JIAPS

Title: Journal of Indian Association of Pediatric Surgeons

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0971-9261

ISSN (Electronic): 1998-3891

Publication date (Print): Jan-Mar 2012

Volume: 17

Issue: 1

Pages: 40-42

Affiliations

[1]Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India

Author notes

Address for correspondence: Dr. Vidyanand P. Deshpande, Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi – 110002, India. E-mail: dr_vidyanand@ 123456rediffmail.com

Article

Publisher ID: JIAPS-17-40

DOI: 10.4103/0971-9261.91088

PMC ID: 3263040

PubMed ID: 22279366

SO-VID: f6dab865-6b28-434f-a6ff-044aef8babb5

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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