Pancreatic heterotopia of the duodenum: anatomic anomaly or clinical challenge?
BACKGROUND
Pancreatic heterotopia (PH) is a common congenital anomaly and can occur anywhere in the gastrointestinal tract (GIT). In most cases, these heterotopias are asymptomatic and are only incidentally detected upon pathohistological examination or autopsy. We analyzed our cases of duodenal PH with respect to their clinical relevance and impact.


METHODS
Our prospectively collected pancreatic database was retrospectively analyzed. Thirty-four cases of duodenal PH were found. Specimens were reviewed by a GI pathologist. Classification was performed according to Heinrich (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts).


RESULTS
From January 2000 to June 2009, we performed 534 pancreatic head resections. Thirty-two patients (6.0%) were found to have duodenal PH. Indications for pancreatic resections (pylorus-preserving pancreaticoduodenectomy, n = 26; Whipple, n = 6) were as follows: chronic pancreatitis, n = 16; malignancies, n = 9; cystic neoplasms, n = 5; and neuroendocrine neoplasms, n = 2. PH was also detected after two partial duodenal resections. In total, two cases of duodenal PH were found to be symptomatic. According to Heinrich, the following types were found: Type I, n = 12; Type II, n = 17; and Type III, n = 5 (total n = 34).


CONCLUSIONS
PH is rare and in most cases detected incidentally during pathohistological examination. However, in two of our patients, surgery was performed due to symptoms. Therefore, in patients with unclear pancreatoduodenal lesions, PH should be considered as a possible diagnosis. Resection is indicated for symptomatic cases.
Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany. marius.distler@uniklinikum-dresden.de
Marius
M
Distler
Felix
F
Rückert
Daniela
D
Aust
Hans-Detlev
HD
Saeger
Robert
R
Grützmann
D000328:Adult; D000368:Aged; D002828:Choristoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004378:Duodenal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010179:Pancreas; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy
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