Heterotopic pancreatitis: gastric outlet obstruction due to an intramural pseudocyst and hamartoma.
Heterotopic pancreas, usually a silent gastrointestinal malformation, may become clinically evident when complicated by chronic inflammation. We report a case of pancreatitis and extensive pseudocyst formation in the gastric antrum, which caused gastric outlet obstruction. The diagnosis was obscured by a history of emesis during pregnancy and a previously resected gastric polyp. The nature of the obstructive lesion was not diagnosed preoperatively in spite of endosonographic evaluation. Intraoperatively, a cystic tumor of the stomach wall was found, the lesion was excised, and a pyloroplasty was performed to close the excision site. Histology revealed heterotopic pancreatic tissue with chronic inflammation, fibrosis and pseudocyst formation and adjacent to this lesion a myoglandular hamartoma. The patient is symptom-free two years after surgery and no recurrence was found. The nature of heterotopic pancreatic tissue, its diagnosis and management are discussed.
Eisenberger
C F
CF
Klinik und Poliklinik für Chirurgie, Abteilung für Allgemeinchirurgie, Germany.
Kropp
A
A
Langwieler
T E
TE
Gocht
A
A
Izbicki
J R
JR
Knoefel
W T
WT
D000328:Adult; D002828:Choristoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D017219:Gastric Outlet Obstruction / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006222:Hamartoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D010192:Pancreatic Pseudocyst / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010195:Pancreatitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011644:Puerperal Disorders / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011708:Pylorus / Q000473:pathology / Q000601:surgery; D013272:Stomach Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery