Diagnosis and therapeutic management of cystic dystrophy of the duodenal wall in heterotopic pancreas. A case report and revision of the literature.
BACKGROUND
Cystic dystrophy in heterotopic pancreas is a rare and serious condition. Diagnosis is difficult because of non-specific clinical manifestations and radiologic and endoscopic imaging are pivotal. Therapeutic management is still under debate.


METHODS
We describe a case of cystic dystrophy of the duodenal wall in heterotopic pancreas complicated with chronic pancreatitis and pancreatic cystadenoma.


CONCLUSIONS
Computed tomography and magnetic resonance are very useful in demonstrating the presence of cysts in a thickened duodenal wall but, for the most part, endoscopic ultrasonography is the most useful imaging examination. The choice of different therapeutic options is still under debate; although some authors have proposed a medical approach using octreotide or endoscopic treatment for selected patients, a pancreaticoduodenectomy is usually proposed for symptomatic patients.


CONCLUSIONS
When surgery is needed, a pancreaticoduodenectomy is preferred, reserving by-pass procedures for high risk patients. Because of the non-specific clinical manifestation and the very difficult diagnosis and therapeutic management, these patients should be studied and treated in specialized and dedicated centers.
Galloro
Giuseppe
G
Department of General, Geriatric Oncological Surgery and Advanced Technology, University of Naples Federico II, School of Medicine, Naples, Italy. galloro.g@tin.it
Napolitano
Vincenzo
V
Magno
Luca
L
Diamantis
Giorgio
G
Nardone
Gerardo
G
Bruno
Marika
M
Mollica
Carmine
C
Persico
Giovanni
G
D000328:Adult; D002828:Choristoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D018291:Cystadenoma, Mucinous / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D004378:Duodenal Diseases; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010179:Pancreas; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis*; D035583:Rare Diseases; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional