title: Heterotopic pancreas mimicking cholangiocarcinoma. Case report and literature review.
abstract: BACKGROUND
  Majority of the patients developing obstructive jaundice have an underlying malignancy. Identification of a benign pathology like heterotopic pancreas as an aetiology is uncommon and usually occurs only subsequent to a major operation.
  
  
  METHODS
  We report a case of heterotopic pancreas adjacent to the ampulla of Vater mimicking distal cholangiocarcinoma. A 47-year-old patient presented with abdominal pain and obstructive jaundice. ERCP demonstrated a distal common bile duct stricture suspicious of cholangiocarcinoma. He underwent a pylorus-preserving pancreaticoduodenectomy. Histology showed a nodule of heterotopic pancreatic tissue adjacent to the ampulla.
  
  
  CONCLUSIONS
  We have reviewed the literature on heterotopic pancreas of the periampullary region presenting with biliary obstruction. This is a rare entity and remains difficult to diagnose, despite advances in radiological and endoscopic imaging techniques. For symptomatic patients with an established diagnosis of periampullary heterotopic pancreas, local excision may be sufficient. However, in the absence of unequivocal imaging or histological confirmation of benign pathology, and when there is a suspicion of underlying malignancy, pancreaticoduodenectomy may be the only treatment option, as in this case.
authors.affiliation: Departments of Surgery, Royal London Hospital, London, United Kingdom.
authors.forename: Atindriya
authors.initials: A
authors.lastname: Biswas
authors.forename: Ehab A
authors.initials: EA
authors.lastname: Husain
authors.forename: Roger M
authors.initials: RM
authors.lastname: Feakins
authors.forename: Ajit T
authors.initials: AT
authors.lastname: Abraham
mesh_terms: D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D002828:Choristoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003135:Common Bile Duct / Q000473:pathology; D003137:Common Bile Duct Diseases / Q000209:etiology* / Q000473:pathology; D004378:Duodenal Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas