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Ectopic pancreas, also known as heterotopic pancreas, is a rare condition in which the pancreatic tissue is found outside its usual location in the gastrointestinal (GI) tract. It is commonly asymptomatic and benign, and is often discovered incidentally during routine imaging, endoscopy, surgery, or autopsy. However, complications can arise, such as inflammation, bleeding, obstruction, or even malignant transformation, necessitating surgical intervention in some cases. Ectopic pancreas at the ampulla of Vater (EPAV) is an extremely rare condition and a diagnostic and therapeutic nightmare. Most cases have been diagnosed through invasive surgery due to concerns for malignancy, which carries significant morbidity and mortality. In our case, endoscopic snare papillectomy (ESP) was employed to establish a diagnosis. Thus far, only one other case has been reported in which ESP was used to diagnose and resect a pancreatic heterotopia at the ampulla. [ABSTRACT FROM AUTHOR]

Ectopic pancreas within the mesentery is rare. In this case report, a 61-year-old man with an ectopic pancreas within the jejunal mesentery for over 20 years developed chronic pancreatitis that progressed to acute exacerbation. Our computed tomography (CT) performed for acute abdomen assessment suggested acute appendicitis or Meckel's diverticulitis. However, a CT scan taken 20 years ago revealed a structure indicative of an ectopic pancreas in the mesentery, and further imaging findings taken 10 and 4 years ago confirmed progression to chronic pancreatitis. Furthermore, we found a pancreatic stone confined in the luminal structure that corresponded to the main pancreatic duct; this stone eventually caused acute exacerbation. In summary, we report a case of mesenteric ectopic pancreas that showed typical findings of progression and acute exacerbation of chronic pancreatitis on CT. [ABSTRACT FROM AUTHOR]

Objective Heterotopic pancreas (HP) is a condition in which there is well-differentiated pancreatic tissue that lacks any anatomic or vascular contact with the pancreatic gland. It normally arises from the stomach but can be found in other locations. Although it is usually asymptomatic, obstructive symptoms, bleeding, or malignant degeneration can occur. The incidence is very low, but it is significantly more common in patients with esophageal atresia (EA). The aim of this study is to evaluate the incidence of HP in patients with and without EA and to compare the results in both groups. Material and Methods We conducted a 2-year prospective study in pediatric patients who benefited from an upper gastrointestinal endoscopy. Patients were divided into two groups: group "A" comprised patients with EA and group "B" those without EA. The variables analyzed were the clinical presentation, presence of HP, location, associated malformations, genetic disorders, and management. Results A total of 192 consecutive patients were included in the study: 51 (26.6%) in group A and 141 (73.4%) in group B. Indications for endoscopy in group B were eosinophilic esophagitis in 37 (19.2%) patients, celiac disease in 23 (11.95%) patients, and other disorders in 81 (42.2%) patients. Gastric HP was found in seven patients, all of them in group A. All lesions were hosted in the prepyloric antrum. The prevalence of HP in groups A and B was 13.7 and 0%, respectively (p < 0.05). Female gender was predominant in patients with AE and HP, this result being statistically significant (p = 0.044). No other associated malformation or genetic syndrome studied showed association with HP. Only one patient debuted with upper gastrointestinal (GI) bleeding and required excision, while six patients were asymptomatic. The mean follow-up was 54 months (range: 45–78 months). Conclusion The incidence of gastric HP is more common in patients with EA, with the female gender being a risk factor for their association. Active search and follow-up is recommended as it may become symptomatic anytime and need resection. [ABSTRACT FROM AUTHOR]

Objective To explore the imaging manifestations of ectopic pancreas based on endoscopic findings in order to find out the causes of miss diagnosis and to improve the diagnostic accuracy. Methods The clinical and CT imaging data of ectopic pancreas patients who underwent CT examination and confirmed by endoscopy and pathology microscopy at Air Force Medical Center from July 2018 to March 2023 were collected. Their imaging characteristics were analyzed according to the endoscopic findings and the miss diagnosis was analyzed. Results There were 13 patients with ectopic pancreas and 3 of them had no obvious symptoms. Ten patients presented with gastrointestinal symptoms, including epigastric discomfort and pain, incomplete obstruction, and melena. Lesion sites: 8 cases were located in the gastric antrum and 5 cases were located in the small intestine. In this group, two patients showed apical erosions and glandular opening-like depressions on endoscopic results, but only one patient showed a “ductal sign” shown by CT scanning. None of the 13 patients in this group made ectopic pancreatic diagnosis on imaging, of which 4 were diagnosed as thickening of the gastrointestinal tract wall, 3 were diagnosed as gastrointestinal stromal tumor, 3 were diagnosed as benign tumors and 3 had no obvious abnormalities. Conclusions The imaging diagnosis of ectopic pancreas should be made by closely combinating with the results of endoscopy to improve the accuracy of imaging diagnosis. CT is of great significance for the diagnosis of ectopic pancreas, and adequate preparation before gastrointestinal examination is an important step to avoid misdiagnosis.

Objective: Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients. Methods: We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed. Results: The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel's diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel's diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient's age, the lesion site and size, and coexisting diseases. Conclusions: Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel's diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options. [ABSTRACT FROM AUTHOR]

Heterotopic pancreas (HP) also known as ectopic pancreas, pancreatic crest or accessory pancreas is the normal pancreatic tissue, found in a remote area other than its natural location, with no anatomic or vascular connection to main pancreatic tissue. It is a rare congenital anomaly and has been reported at many locations such as stomach (antrum) and small intestine. HP is usually an incidental finding and asymptomatic, however there are reports of pancreatitis, obstruction, perforation and malignant transformation as uncommon manifestations. Diagnosis of HP is primarily based on histological examination either by biopsy or surgical excision. Surgery is the standard treatment for symptomatic HP patients. Herein, we present a case of a 58-year-old female, who presented to us with intractable diarrhoea due to HP in the jejunum and underwent minimally invasive surgery for definitive diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective To explore the imaging manifestations of ectopic pancreas based on endoscopic findings in order to find out the causes of miss diagnosis and to improve the diagnostic accuracy. Methods The clinical and CT imaging data of ectopic pancreas patients who underwent CT examination and confirmed by endoscopy and pathology microscopy at Air Force Medical Center from July 2018 to March 2023 were collected. Their imaging characteristics were analyzed according to the endoscopic findings and the miss diagnosis was analyzed. Results There were 13 patients with ectopic pancreas and 3 of them had no obvious symptoms. Ten patients presented with gastrointestinal symptoms, including epigastric discomfort and pain, incomplete obstruction, and melena. Lesion sites: 8 cases were located in the gastric antrum and 5 cases were located in the small intestine. In this group, two patients showed apical erosions and glandular opening-like depressions on endoscopic results, but only one patient showed a "ductal sign" shown by CT scanning. None of the 13 patients in this group made ectopic pancreatic diagnosis on imaging, of which 4 were diagnosed as thickening of the gastrointestinal tract wall, 3 were diagnosed as gastrointestinal stromal tumor, 3 were diagnosed as benign tumors and 3 had no obvious abnormalities. Conclusions The imaging diagnosis of ectopic pancreas should be made by closely combinating with the results of endoscopy to improve the accuracy of imaging diagnosis. CT is of great significance for the diagnosis of ectopic pancreas, and adequate preparation before gastrointestinal examination is an important step to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

Worku Mekonnen Sefefe,1 Destaw Biadgie Tesfaw,2 Andualem Dagne Tebikew,2 Assefa Sisay Ayenew,3 Bereket Amare Dencha,4 Temesgen Agegnehu Abebe1 1Department of Surgery, Debre Markos University (DMU), Debre Markos, Amhara, Ethiopia; 2Department of Surgery, Bahir Dar University, Bahir dar, Amhara, Ethiopia; 3Department of Surgery, Akesta General Hospital, Wollo, Amhara, Ethiopia; 4Department of Pathology, Bahir Dar University, Bahir dar, Amhara, EthiopiaCorrespondence: Worku Mekonnen Sefefe, Department of Surgery, Debre Markos University (DMU), Debre Markos, Amhara, Ethiopia, Tel +251912101424, Email workumekonnen04@gmail.comBackground: Ectopic pancreas (EP), characterized by pancreatic tissue outside its usual location, poses diagnostic challenges due to its asymptomatic nature in most cases. Gastric lesions are often symptomatic, causing epigastric pain or gastric outlet obstruction. Rarely, jejunal lesions can lead to intestinal obstruction or intussusception. The elusive preoperative diagnosis lacks specific biochemical markers, relying on intraoperative biopsy and histopathology as gold standards.Case Presentation: We present a unique case of a 37-year-old female with 12-hour crampy abdominal pain, bilious vomiting, blood-mixed diarrhea, abdominal distension, and obstructive symptoms. Imaging revealed jejunojejunal intussusception with a jejunal mass as the lead point. Intraoperatively, also identified jejunal mass as lead point. Resection of mass and end-to-end jejunojejunal anastomosis were performed, resulting in a successful outcome. Histopathological examination identified a type I ectopic pancreas within the muscularis propria. Twelve months postoperatively, the patient exhibited no stricture or recurrence.Conclusion: Ectopic pancreas, with varied symptoms, poses diagnostic hurdles. Despite the diagnostic challenges, surgical excision remains the optimal treatment for symptomatic cases. This report contributes to the limited literature on ectopic pancreas, emphasizing the importance of considering this entity in the differential diagnosis of gastrointestinal pathology.Keywords: ectopic pancreas, pancreatic heterotopia, jejunojejunal intussusception, lead point, Ethiopia

Abstract The occurrence of ectopic pancreas in the mediastinum is rare. Herein, we report a 22-year-old female who presented with right shoulder pain, dysphagia, fever and headaches. Chest computer tomography revealed a mass in the posterior mediastinum with accompanying signs of acute mediastinitis. Needle biopsy and fine-needle aspiration revealed ectopic gastral tissue and ectopic pancreas tissue, respectively. Surgical resection was attempted due to recurring acute pancreatitis episodes. However, due to chronic-inflammatory adhesions of the mass to the tracheal wall, en-bloc resection was not possible without major tracheal resection. Since then, recurring pancreatitis episodes have been treated conservatively with antibiotics. We report this case due to its differing clinical and radiological findings in comparison to previous case reports, none of which pertained a case of ectopic pancreas tissue in the posterior mediastinum with recurring acute pancreatitis and mediastinitis.

Case presentation: A 61-year-old female was referred to our hospital with a neoplastic lesion in the duodenum. Computed tomography with contrast enhancement revealed a 10-mm tumor in the duodenum. Upper gastrointestinal endoscopy revealed a submucosal tumor-like lesion in the descending part of the duodenum. Endoscopic ultrasound revealed a well-defined hypoechoic tumor. Biopsy and immunohistochemical findings including negative Synaptophysin and Chromogranin A staining and positive Trypsin and BCL10 staining suggested a carcinoma with acinar cell differentiation. Pancreatoduodenectomy was performed, and the resected specimen had a 15-mm solid nodule in the submucosal layer of the duodenum. Pancreatogram of the resected specimen revealed a tumor localized in the accessory papilla region. In histopathological examination, the tumor was found in the submucosa of the duodenum with pancreatic tissue present nearby, and these were separated from the pancreatic parenchyma by the duodenal muscle layer. These findings led to a diagnosis of acinar cell carcinoma originating from the accessory papilla of the duodenum. Conclusion: Acinar cell carcinoma originating from the accessory papilla of the duodenum is exceptionally rare, with no reported cases to date. The origin was considered to be pancreatic tissue located in the accessory papilla region. [ABSTRACT FROM AUTHOR]

The occurrence of ectopic pancreas in the mediastinum is rare. Herein, we report a 22-year-old female who presented with right shoulder pain, dysphagia, fever and headaches. Chest computer tomography revealed a mass in the posterior mediastinum with accompanying signs of acute mediastinitis. Needle biopsy and fine-needle aspiration revealed ectopic gastral tissue and ectopic pancreas tissue, respectively. Surgical resection was attempted due to recurring acute pancreatitis episodes. However, due to chronic-inflammatory adhesions of the mass to the tracheal wall, en-bloc resection was not possible without major tracheal resection. Since then, recurring pancreatitis episodes have been treated conservatively with antibiotics. We report this case due to its differing clinical and radiological findings in comparison to previous case reports, none of which pertained a case of ectopic pancreas tissue in the posterior mediastinum with recurring acute pancreatitis and mediastinitis. [ABSTRACT FROM AUTHOR]

Background: Ectopic pancreas is a benign subepithelial tumor with an abnormal anatomical position, typically diagnosed incidentally as it does not produce symptoms and is challenging to identify in paraclinical studies. The incidence is very low, so our objective is to present the case of a patient with ectopic pancreas as a rare cause of obscure gastrointestinal bleeding. Clinical case: A 70-year-old man presented with melena, anemia, and weight loss. The initial approach involved endoscopic studies (panendoscopy, colonoscopy, enteroscopy), a tagged red blood cell scan and computed tomography, none of which identified the bleeding site. Therefore, an exploratory laparoscopy was performed, revealing a 3 x 3 cm exophytic lesion in the proximal jejunum, which was completely resected. Histopathology confirmed an ectopic pancreas. Conclusions: This condition is an uncommon but potentially serious cause of gastrointestinal bleeding, as the definitive diagnosis is often delayed. Therefore, clinical suspicion is crucial for early diagnosis and timely treatment, involving a multidisciplinary team of specialists in gastroenterology, radiology, pathology, and general surgery. In this manuscript, we present one of the few reported cases of ectopic pancreas as the cause of mid-intestinal bleeding. [ABSTRACT FROM AUTHOR]

Heterotopic pancreas is a relatively rare condition that may be associated to clinical complaints or signs. Here, we report a case of gastric heterotopic pancreas assictaed to ductal adenocarcinoma. Obstructive jaundice was the initial symptom prompting medical intervention. A 73-year-old male patient presented with yellow staining of the skin and sclera, and dull epigastric pain. Contrast-enhanced computed tomography showed stenosis of the extrahepatic distal bile duct and mass lesions of the antrum. The patient underwent tumor resection, distal gastrectomy (Billroth II), and common bile duct exploration. Postoperative pathological examination revealed an adenocarcinoma located in the wall of the gastric antrum. Immunohistochemical results suggested that the tumor originated from the pancreas. Heterologous pancreatic tissue and a dilated pancreatic duct were found in the tumor. These findings suggest malignant transformation of the gastric heterotopic pancreas. Of note, jaundice as clinical complaint for adenocarcinoma associated to gastric heterotopic pancreas.

Ectopic pancreas, or the presence of pancreatic tissue separate from the anatomic pancreas, is rarely reported in locations other than the stomach or duodenum. A 43-year-old female was found to have a large jejunal mesenteric ectopic pancreas causing ectopic pancreatitis during workup for frequent episodes of abdominal pain. We present the imaging findings and postresection pathology findings of a rare jejunal ectopic pancreas and discuss the potential complications of this unique condition.

Ectopic pancreas (EP) is an uncommon, congenital focus of pancreatic tissue that is discontinuous with the principal pancreas. A 62-year-old female underwent multiple investigations for chronic epigastric pain. EP was identified intra-operatively. On retrospection, earlier imaging showed a thickened segment of jejunum with inflammation of the surrounding small bowel mesentery, suggestive of jejunal EP pancreatitis. Histology confirmed ectopic pancreatic tissue, with sections of the EP showing evidence of previous acute and chronic pancreatitis. When no cause for chronic abdominal pain is found, diagnostic laparoscopy should be considered, and the small bowel inspected, to further investigate for rare causes of abdominal pain, such as EP. [ABSTRACT FROM AUTHOR]

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Abstract A 25‐year‐old man was referred to our center for investigation of a gastric submucosal tumor and an ulcer that had developed on its oral side. Endoscopic ultrasonography findings suggested the presence of an ectopic pancreas, and treatment with an oral proton pump inhibitor was planned for the ulcer. Over the subsequent 3 years, the patient endured recurring epigastric pain and episodes of passing black stools. Emergency endoscopy revealed that the morphology of the gastric submucosal tumor had transformed into a pedunculated polyp‐like morphology with a bleeding ulcer at the apex of the lesion. Endoscopic hemostasis using hemostatic forceps was performed. However, the patient continued to pass black stools. In light of the persistent symptoms and unique morphology of the lesion, endoscopic resection was attempted as a curative approach. The lesion was excised by hot snare polypectomy. Post‐treatment, the patient exhibited no signs of recurrence, marking a successful resolution. Three months later, a gastroduodenal endoscopy showed that the excised site had undergone scar formation without recurrence of the lesion. This case holds significant clinical value as it demonstrates the efficacy of a minimally invasive treatment strategy in managing repeated bleeding ulcerations of an ectopic pancreas, ultimately achieving a complete cure.

Abstract Background Intestinal duplication and ectopic pancreas are two rare independent congenital anomalies. Few reports describe cases of patients with ectopic pancreas in an intestinal duplication causing acute peritonitis. Case presentation A 31-year-old man was admitted to the hospital for epigastric pain. The patient was diagnosed with acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, with intestinal malrotation. The patient underwent the partial resection of the jejunum and Ladd’s procedure. The histopathological findings indicated ectopic pancreatitis in the jejunal duplication. Conclusions We presented the case of acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication in an adult with intestinal malrotation. Surgery is the primary treatment and is necessary for a definitive diagnosis.

Ectopic pancreatic tissue is a rare congenital abnormality defined as the abnormal location of pancreatic tissue outside the anatomical site of the pancreas without any anatomical or vascular connection to it, which is often discovered incidentally. This is a case of a 40‐year‐old man who was admitted to our surgical department for emergency cholecystectomy due to acute gangrenous cholecystitis. Preoperative ultrasound imaging was indicative only of multiple stones in the gallbladder. Postoperative histopathological examination revealed an area of wall thickening in the neck region of the gallbladder consists of ectopic pancreatic tissue. We emphasize the role of a precise pathologic examination even in routine surgical specimens such as a cholecystectomy specimen, since no preoperative evaluation can be affirmative of such incidental but momentous histopathologic findings. Anatomical pathologists must be aware of the rare presentation of Ectopic Pancreatic Tissue (EPT) in gallbladder which may masquerade as a malignancy. [ABSTRACT FROM AUTHOR]

Background: Intestinal duplication and ectopic pancreas are two rare independent congenital anomalies. Few reports describe cases of patients with ectopic pancreas in an intestinal duplication causing acute peritonitis. Case presentation: A 31-year-old man was admitted to the hospital for epigastric pain. The patient was diagnosed with acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, with intestinal malrotation. The patient underwent the partial resection of the jejunum and Ladd's procedure. The histopathological findings indicated ectopic pancreatitis in the jejunal duplication. Conclusions: We presented the case of acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication in an adult with intestinal malrotation. Surgery is the primary treatment and is necessary for a definitive diagnosis. [ABSTRACT FROM AUTHOR]

Gastric ectopic pancreas (EP) is an uncommon congenital anomaly in which pancreatic tissue with no anatomic connection to the main pancreas is found in the stomach. Gastric EP is often discovered incidentally when a nonspecific submucosal tumor is found in endoscopic studies or other imaging examinations. Tissue characterization by biopsy or fine-needle aspiration is required as endoscopic findings alone cannot exclude malignancy. The authors present 2 cases of gastric EP incidentally detected on endoscopy, which underwent further characterization by magnetic resonance imaging (MRI). In both cases, MRI showed submucosal gastric lesions, isointense to the orthotopic pancreas in all sequences, including hyperintensity on T1-weighted images. Furthermore, the lesions showed bright arterial phase enhancement, paralleling the native pancreas. MRI may provide the best non-invasive imaging method for evaluating gastric submucosal lesions. This report intends to show that EP shows a characteristic MR appearance that allows differentiation from other submucosal lesions.

Abstract Ectopic pancreatic tissue is a rare congenital abnormality defined as the abnormal location of pancreatic tissue outside the anatomical site of the pancreas without any anatomical or vascular connection to it, which is often discovered incidentally. This is a case of a 40‐year‐old man who was admitted to our surgical department for emergency cholecystectomy due to acute gangrenous cholecystitis. Preoperative ultrasound imaging was indicative only of multiple stones in the gallbladder. Postoperative histopathological examination revealed an area of wall thickening in the neck region of the gallbladder consists of ectopic pancreatic tissue. We emphasize the role of a precise pathologic examination even in routine surgical specimens such as a cholecystectomy specimen, since no preoperative evaluation can be affirmative of such incidental but momentous histopathologic findings. Anatomical pathologists must be aware of the rare presentation of Ectopic Pancreatic Tissue (EPT) in gallbladder which may masquerade as a malignancy.

Abstract Background Gastric duplication cyst associated with ectopic pancreas is rare and we aimed to alert clinician to this congenital anomaly. Case presentation A 15-year-old girl presented with intermittent vomiting. Gastroscopy showed a submucosal tumor with an approximate diameter of 40 mm in the anterior wall of the gastric antrum. The lesion had a central umbilication and was diagnosed preliminarily as gastric ectopic pancreas with pseudocyst formation on the basis of its appearance. However, computed tomographic scan showed a thick-walled cystic lesion with an enhanced outline of the cystic wall in the antrum of stomach, suggestive of duplication cyst. Serum amylase was normal. Endoscopic ultrasonography revealed a solid-cystic lesion; the solid portion were inhomogeneously mixed with echoes, and had indistinct border to muscularis propria; the cystic portion had echogenic internal mucosal layer and distinct border to muscularis propria. Endoscopic submucosal dissection (ESD) was suggested for the patient to relieve symptoms and diagnose the lesion definitely. The operation procedure was uneventful and the solid-cystic lesion was resected completely. Histopathologic examination revealed that the solid portion was ectopic pancreas, and the cystic portion was gastric duplication cyst. After resection, the patient discharged successfully and neither symptoms nor tumors recurred during the 9 months follow-up period. Conclusions This is the first case of a solid-cystic lesion with central umbilication in the stomach diagnosed as gastric duplication cyst associated with ectopic pancreas. ESD could be an optional treatment to provide a definitive diagnosis.

Heterotopic pancreas is defined as the presence of ectopic pancreatic tissue outside boundaries of the pancreas without vascular and duct system connection with the pancreas. Ectopic locations are mostly found anywhere in the gastrointestinal tract such as the stomach (24–38%), the duodenum (9–36%), and the jejunum (0.5–27%). Clinical manifestations are not specific, vague, and misdiagnosed another digestive disease. Most cases are incidentally detected by histological examination of specimens resected for different pathologies during endoscopy, surgery, or even autopsy. We report a case of a 31-year-old man who admitted to the hospital with the reason of epigastric pain for 3 days. Clinical examination showed mild epigastric tenderness. The past medical history of patient was unremarkable. A submucosal lesion was observed in the first part of the duodenum during endoscopy. Computed tomography and endoscopic ultrasonography findings were suspected to be heterotopic pancreatic tissue. After laparoscopic surgery for biopsy, it was histologically confirmed duodenal ectopic pancreas. It is difficult to differentiate gastrointestinal pancreatic heterotopia from gastrointestinal stromal tumors, leiomyoma, or lymphomas by using endoscopy because ectopic tissue is mostly located in the submucosal layer. In addition, rare cases of ectopic pancreatic tissue transform malignancy. Surgical treatment should be considered to take adequate tissue samples for biopsy or resect the lesions in symptomatic patients. Duodenal pancreatic heterotopia is an uncommon congenital malformation and most patients are asymptomatic. Histological examination is essential to exclude malignant lesions and to have an appropriate treatment.

The ectopic pancreas is a benign subepithelial tumor (SET) mostly found incidentally in the stomach and duodenum. Here, we present computed tomography (CT) scans and endoscopic ultrasound (EUS) images from a 71-year-old Taiwanese man newly diagnosed with colonic adenocarcinoma. CT examination revealed a mural nodule in the proximal jejunum, with good enhancement after IV contrast medium administration. Push enteroscopy was performed to localize the lesion and evaluate its nature, and a 1 cm subepithelial lesion was found. The lesion appeared hyperechoic within the submucosal layer of the bowel wall on endoscopic ultrasound examination. A tattoo was performed, and the lesion was removed during the resection of colon cancer. The histopathology confirmed the presence of pancreatic tissue inside. As far as we know, this is the first description in the literature of an endoscopic ultrasound finding of a jejunal ectopic pancreas. [ABSTRACT FROM AUTHOR]

An ectopic pancreas is defined as pancreatic tissue outside its normal location, anatomically separated from the pancreas.The transcription factor pancreas/duodenum homeobox protein 1 (PDX1) is involved in maintaining the pancreas and functions in early pancreatic development, beta cell differentiation, and endocrine non beta cells. Pancreatic transcription factor 1 subunit alpha (PTF1A) affects exocrine cell formation and regulation of acinar cell identity, and is expressed in exocrine cells as a transcription factor. The depletion of SALL4 disrupts self-renewal and induces differentiation.To clarify which of PDX1, PTF1A, or SALL4 determines the difference in Heinrich's classification, we examined the localization and number of positive cells. We analyzed the differential expression of PDX1, PTF1A, and SALL4 in large and small ducts in ectopic pancreas by immunohistochemistry. Results showed that the number of PTF1A-positive cells in large ducts was more widespread in type I than in type II in the gastro-duodenum, and more SALL4-positive cells were noticed in large ducts than in small ducts in the gastro-duodenum of type II. Our results revealed that PTF1A might promote exocrine differentiation in developing the pancreatic tissues, and that those with widespread expression differentiate into exocrine cells.

The ectopic pancreas is a relatively rare congenital condition, defined as pancreatic tissue lacking anatomical or vascular continuity with the normal pancreatic body. The ectopic pancreas is most frequently found in the stomach, usually asymptomatic and discovered incidentally. We report the case of a 72-year-old man who was diagnosed with cancer in the gastric vestibule. Distal gastrectomy was performed, and 3 cm of the ectopic pancreas was found on the anterior surface of the pylorus intraoperatively. The gastroduodenal artery was not found by approaching the inferior border of the pancreas but by following the branches from the common hepatic artery. Posterior view CT confirmed that the GDA terminated in the ectopic pancreas. An ectopic pancreas may be associated with vascular anomalies. Clinicians must consider the possibility of vascular anomalies when operating on patients with an ectopic pancreas. If the gastroduodenal artery cannot be found intraoperatively, identification should be attempted by following the common hepatic artery.

Abstract A 40‐year‐old Japanese male presented with epigastric pain and loss of appetite at a general hospital three years ago. Computed tomography revealed massive thickening of the gastric wall, and gastroscopy revealed diffuse erythema and edematous thickening of the gastric mucosa. Thereafter, epigastric pain and gastric wall thickening recurred frequently, causing an inability to intake food. Conservative treatment was marginally effective; therefore, a distal gastrectomy was performed. Postoperatively, the patient resumed food intake without complications. Histopathological examination of the surgical specimen revealed Heinrich type 1 gastric ectopic pancreas (EP) with pancreatitis. In this case, the gastric wall's massive thickening was caused by gastric EP's pancreatitis. Although there are some reports of pancreatitis of gastric EP, there are no detailed reports of endoscopic findings, including endoscopic ultrasonography and the disease progression. Recurrent pancreatitis of EP leads to forming a septum within the gastric wall, resulting in a hematoma. Eventually, irreversible narrowing of the gastric lumen may occur, as observed in the present case. We consider this an important case report presenting detailed pathogenesis supported by endoscopic and pathohistological findings of surgical specimens. Our study will help in the early diagnosis and better management of the condition.

Background: Gastric duplication cyst associated with ectopic pancreas is rare and we aimed to alert clinician to this congenital anomaly.Case Presentation: A 15-year-old girl presented with intermittent vomiting. Gastroscopy showed a submucosal tumor with an approximate diameter of 40 mm in the anterior wall of the gastric antrum. The lesion had a central umbilication and was diagnosed preliminarily as gastric ectopic pancreas with pseudocyst formation on the basis of its appearance. However, computed tomographic scan showed a thick-walled cystic lesion with an enhanced outline of the cystic wall in the antrum of stomach, suggestive of duplication cyst. Serum amylase was normal. Endoscopic ultrasonography revealed a solid-cystic lesion; the solid portion were inhomogeneously mixed with echoes, and had indistinct border to muscularis propria; the cystic portion had echogenic internal mucosal layer and distinct border to muscularis propria. Endoscopic submucosal dissection (ESD) was suggested for the patient to relieve symptoms and diagnose the lesion definitely. The operation procedure was uneventful and the solid-cystic lesion was resected completely. Histopathologic examination revealed that the solid portion was ectopic pancreas, and the cystic portion was gastric duplication cyst. After resection, the patient discharged successfully and neither symptoms nor tumors recurred during the 9 months follow-up period.Conclusions: This is the first case of a solid-cystic lesion with central umbilication in the stomach diagnosed as gastric duplication cyst associated with ectopic pancreas. ESD could be an optional treatment to provide a definitive diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Background Protrusion of the lateral contour of the pancreatic head is a pancreatic morphological abnormality, which is known as rare shape atypia. We present a rare case of protrusion of the lateral contour of the pancreatic head, which was challenging to distinguish from an ectopic pancreas. Case presentation The patient was a 40-year-old man with a history of acute pancreatitis that occurred twice in the past. He complained of epigastric pain since the day before the visit; his blood workup showed high serum amylase level and a CT scan revealed a 25-mm-large mass with contrast effect from the anterior wall of the gastric pylorus to the duodenum and increased surrounding fatty tissue density. Endoscopic ultrasonography revealed a mass lesion in the gastric pylorus with continuity with the gastric wall and suspected partial continuity with the pancreatic head. Thus, the possibility of pancreatic morphological abnormality or an ectopic pancreas was considered. Following which, resection was attempted and intraoperative findings showed a wide extension of the pancreatic parenchyma from the pancreatic head to the anterior wall of the gastric pylorus to the duodenal bulb. Since the patient only had mild pancreatitis, the resection was judged to be too invasive and was completed by exploratory laparoscopy. Conclusions Even if the findings on preoperative CT are suspicious for an ectopic pancreas or tumor, a pancreatic morphological abnormality, such as a protrusion of the lateral contour of the pancreatic head, should be included in the differential diagnosis.

BackgroundThe ectopic pancreas is a kind of congenital malformation formed during embryonic development, which has no anatomical relationship with the normal pancreas and is a rare solid disease. The ectopic pancreas in the adrenal glands is extremely rare.Case summaryA 32-year-old man was admitted to the hospital after experiencing elevated blood pressure for 2 years as well as dizziness and blurred vision for 2 weeks. He had an elevated blood pressure of 170/110 mmHg (1 mmHg = 0.133 kPa) on physical examination 2 years ago, without palpitations, chest pain, and chest tightness. Two weeks ago, he presented with dizziness and blurred vision. Blood renin and aldosterone levels were elevated. Plain CT and contrast-enhanced CT scan showed nodular thickening of the left adrenal and homogeneous enhancement, which was initially considered adrenal adenoma. The postoperative pathology supported the ectopic pancreas in the left adrenal. After 78 months of postoperative follow-up, no recurrence was observed, but his blood pressure remained persistently high.ConclusionThe ectopic pancreas occurring in the adrenal glands is extremely rare, has no specific clinical symptoms, and is mainly found for other reasons. It can easily be misdiagnosed as an adrenal adenoma. The final confirmation of the diagnosis still depends on the pathological biopsy. A great deal of reporting is still required for whether there is a correlation with elevated blood pressure.

Heterotopic pancreas is defined as the presence of ectopic pancreatic tissue outside boundaries of the pancreas without vascular and duct system connection with the pancreas. Ectopic locations are mostly found anywhere in the gastrointestinal tract such as the stomach (24–38%), the duodenum (9–36%), and the jejunum (0.5–27%). Clinical manifestations are not specific, vague, and misdiagnosed another digestive disease. Most cases are incidentally detected by histological examination of specimens resected for different pathologies during endoscopy, surgery, or even autopsy. We report a case of a 31-year-old man who admitted to the hospital with the reason of epigastric pain for 3 days. Clinical examination showed mild epigastric tenderness. The past medical history of patient was unremarkable. A submucosal lesion was observed in the first part of the duodenum during endoscopy. Computed tomography and endoscopic ultrasonography findings were suspected to be heterotopic pancreatic tissue. After laparoscopic surgery for biopsy, it was histologically confirmed duodenal ectopic pancreas. It is difficult to differentiate gastrointestinal pancreatic heterotopia from gastrointestinal stromal tumors, leiomyoma, or lymphomas by using endoscopy because ectopic tissue is mostly located in the submucosal layer. In addition, rare cases of ectopic pancreatic tissue transform malignancy. Surgical treatment should be considered to take adequate tissue samples for biopsy or resect the lesions in symptomatic patients. Duodenal pancreatic heterotopia is an uncommon congenital malformation and most patients are asymptomatic. Histological examination is essential to exclude malignant lesions and to have an appropriate treatment. [ABSTRACT FROM AUTHOR]

Introduction: Ectopic pancreatic tissue (EPT), also known as Heterotopic pancreas (HP), is a rare congenital anomaly characterized by the presence of pancreatic tissue outside the primary organ. This report presents a case of EPT incidentally discovered in the submucosal area of the small intestine., Case Presentation: A 56-year-old male presented to the emergency department following a high-speed car collision, reporting abdominal pain after impact with the steering wheel. Physical examination revealed left upper quadrant tenderness. Imaging studies showed free fluid in the abdominal and pelvic cavities, mesenteric damage, and increased intestinal wall thickness. Surgical exploration confirmed hemoperitoneum and a non-viable 30 cm segment of the small intestine, which was resected. Subsequent pathological examination revealed a 1.5 cm submucosal mass, diagnosed as EPT. The patient recovered uneventfully and was discharged in stable condition., Clinical Discussion: Clinically significant lesions are typically larger than 1.5 cm and involve the mucosa, with pain as the most common symptom. They can also cause severe complications such as intestinal obstruction, perforation, peritonitis, and gastrointestinal bleeding. Additionally, EPT can be associated with malignant transformations., Conclusion: While often asymptomatic, EPT can lead to significant complications, making surgical resection essential for both symptomatic and incidental cases, particularly since diagnosis is frequently established postoperatively through histological examination. Although trauma may not directly cause EPT, its management in emergency settings can facilitate evaluations that reveal lesions capable of causing severe complications if left undiagnosed. Given the diverse symptoms associated with this condition, EPT should be considered in the differential diagnosis of intestinal lesions., Competing Interests: Declaration of competing interest There are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Pancreatic heterotopia (PH) involves pancreatic tissue located outside its typical anatomical position, lacking vascular or ductal communication with the pancreas. Despite frequently having acini with the capacity to produce digestive enzymes, PH is usually asymptomatic. When symptoms do occur, they typically present in middle to late adulthood and include abdominal pain, nausea, and diarrhea. This clinical presentation is similar to that of Crohn's disease, an autoimmune inflammatory bowel disease (IBD). The presentation of symptomatic PH varies depending on the location of the ectopic pancreatic tissue and its microanatomical constituents, including exocrine and endocrine tissue as well as a duct system. We present a case of a patient who came to medical attention with abdominal pain and was found on colonoscopy to have a non-obstructing stricture of the transverse colon without an associated mass. Biopsies of the area revealed chronic active colitis, leading to a diagnosis of Crohn's disease. Her gastroenterological symptoms remained stable for several years while receiving infliximab infusions until she presented to the emergency department with severe abdominal pain, diarrhea, and sepsis, meeting the criteria for systemic inflammatory response syndrome. Imaging studies revealed a fistula between the previous colonic stricture and the jejunum, again attributed to Crohn's disease. She underwent surgery to remove the fistula between the small and large bowels. Unexpectedly, the resection specimen showed a mass insinuated between the loops of the large intestine, which histological review revealed to be ectopic pancreatic tissue. Following the resection of the ectopic pancreatic tissue, her symptoms resolved without the need for further treatment. In retrospect, the ectopic pancreatic tissue, which contained acini with digestive enzymes, ducts, and islets, may have also caused seemingly unrelated pathology in the patient. Symptomatic PH should be recognized as a pathology that can mimic IBD, prompting reconsideration of the diagnosis in cases of refractory disease while on biologics., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alli et al.)

Abstract Background Ectopic pancreas is basically a benign disease and is not always necessary to be removed. However, all types of neoplasms occurring in the normal pancreas such as ductal adenocarcinomas and intraductal papillary mucinous neoplasms (IPMNs) may develop even within ectopic pancreas. We recently encountered an extremely rare case of ectopic pancreas in the gastric antrum associated with IPMN possessing a GNAS mutation. Case presentation A 71-year-old Japanese woman complained of epigastric pain. Computed tomography and upper gastrointestinal endoscopy showed an intramural cystic mass in the antrum of the stomach. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy did not give a definitive diagnosis, and the patient underwent resection of the lesion. Histology of the resected specimen showed that the gastric intramural lesion was ectopic pancreas. Moreover, the lesion contained dilated duct components with tubulo-villous epithelial proliferation consistent with pancreatic IPMN. Since the covering epithelial cells had highly atypical nuclei, the lesion was diagnosed as IPMN with high grade dysplasia. Immunohistochemistry showed that the IPMN component showed to be MUC2-, MUC5AC-, and CDX2-positive but MUC1- and MUC6-negative. Mutational analyses using genomic DNA revealed that the IPMN component had a mutation of GNAS at exon 8 (Arg201Cys). Conclusion We finally diagnosed this case as gastric ectopic pancreas accompanied by intestinal type IPMN with high grade dysplasia possessing GNAS mutation. Although there were 17 cases of ectopic pancreas with IPMN including 6 cases of gastric ones reported in the English literature, this is the first case of ectopic pancreas with IPMN which was proved to have GNAS mutation. Intimate preoperative examinations including imaging analyses and EUS-FNA biopsy/cytology are recommended to decide whether the lesion has to be resected or not even if they are not effective for getting the right diagnosis.

BackgroundEctopic pancreas is a congenital anomaly in which pancreatic tissue is anatomically separated from the main gland and without vascular or ductal continuity. A case of retroperitoneal ectopic pancreas with adrenal adenoma has never yet been reported.Case PresentationA 54-year-old man presented three masses in the left retroperitoneum, and two of them were resected. The pathologic findings were a retroperitoneal ectopic pancreas with adrenal adenoma.ConclusionWe report an extremely rare case of a retroperitoneal ectopic pancreas and its characterization with dynamic gadolinium-enhanced magnetic resonance imaging (MRI).

Abstract Gastric carcinoma with lymphoid stroma is a rare variant of gastric carcinoma accounting for 1%–7% of gastric carcinomas. Its association with gastric leiomyoma and ectopic pancreas is extremely rare. We herein report an unusual simultaneous occurrence of gastric carcinoma with lymphoid stroma, calcified leiomyoma, and ectopic pancreas.

The ectopic pancreas is a relatively rare congenital condition, defined as pancreatic tissue lacking anatomical or vascular continuity with the normal pancreatic body. The ectopic pancreas is most frequently found in the stomach, usually asymptomatic and discovered incidentally. We report the case of a 72-year-old man who was diagnosed with cancer in the gastric vestibule. Distal gastrectomy was performed, and 3 cm of the ectopic pancreas was found on the anterior surface of the pylorus intraoperatively. The gastroduodenal artery was not found by approaching the inferior border of the pancreas but by following the branches from the common hepatic artery. Posterior view CT confirmed that the GDA terminated in the ectopic pancreas. An ectopic pancreas may be associated with vascular anomalies. Clinicians must consider the possibility of vascular anomalies when operating on patients with an ectopic pancreas. If the gastroduodenal artery cannot be found intraoperatively, identification should be attempted by following the common hepatic artery. [ABSTRACT FROM AUTHOR]

Ectopic pancreas is defined as an abnormally located pancreatic tissue not sufficiently connected with the normal pancreas, which rarely occurs in neonates. To our knowledge, only a few cases of ectopic pancreas have been reported in newborns in South Korea. We report a case of ectopic pancreas as the cause of intussusception and jejunal atresia in a newborn. This clinical association is extremely rare, and this is the first report in South Korea.

Abstract Background Ectopic pancreas (EP) is defined as pancreatic tissue that lacks anatomical or vascular communication with the normal body of the pancreas. Despite improvements in diagnostic endoscopy and imaging studies, differentiating ectopic pancreatic tissue from gastric submucosal diseases remains a challenge. Case presentation Here, we present a case of a 44-year-old woman with severe epigastric pain. Initially, gastric lymphangioma was highly suspected due to a well-demarcated protruding mass with a large size that occurred in the submucosal layer of the gastric antrum and appeared as a cystic lesion. The final correct diagnosis of gastric EP was made during surgery. Conclusion Gastric EP with serous oligocystic adenoma appearing as a giant gastric cyst is extremely rare. The difficulty of making an accurate diagnosis and differential diagnosis is highlighted, which may provide additional clinical experience for the diagnosis of EP with serous oligocystic adenoma in the stomach.

Pancreatic heterotopia (PH) is a common, but typically small (

Introduction and importance: Ectopic pancreas is not uncommon, but ileocecal intussusception caused by ectopic pancreas is extremely rare. Thus far, only approximately 10 cases have been reported. Case presentation: Herein, we report a 47-year-old male who presented with abdominal distension and discomfort without apparent cause, accompanied by nausea but no vomiting or other symptoms. The patient's vital signs were stable, and examination revealed increased bowel sounds, tympanic percussion of the abdomen, and tenderness in the lower right abdomen. After laparoscopic exploration, an irreducible intestinal obstruction was found, which subsequently required open surgery. Pathological examination of the resected portion revealed that the patient's ileocecal intussusception was caused by ectopic pancreas. Clinical discussion: Prior to receiving the pathological report, we were not aware that the patient's abdominal pain may have been attributed to ileocecal intussusception induced by ectopic pancreas. This posed challenges in diagnosis and treatment, underscoring the importance of raising awareness among our colleagues through this case report. Conclusion: Our findings emphasize the need to consider the possibility of abdominal pain caused by ileocecal intussusception induced by ectopic pancreas during the investigation of abdominal pain. • Ileocecal intussusception caused by ectopic pancreas is extremely rare. • Surgery or autopsy is the primary method for diagnosing the disease. • It does not have typical symptoms with diagnostic significance. • Intestinal intussusception caused by ectopic pancreas should not be ignored. [ABSTRACT FROM AUTHOR]

Obesity is a global epidemic, and bariatric surgery is an effective treatment. During this surgery, rare abnormalities in the small intestine, like ectopic pancreas (EP), can be found. A 16-year-old male presented at the surgical clinic with a complaint of morbid obesity, weighing 140 KG. Since he was unable to commit to a diet, bariatric surgery was performed. During the surgery, the gastrointestinal tract was examined, and an incidental finding was noted in the wall of the proximal jejunum. The histopathology report revealed that the excisional biopsy was a complete EP in the proximal jejunum. The patient was discharged from the hospital on the first postoperative day, and his condition remained stable. Our case of EP stood out due to its larger size, measuring 3.5 cm in diameter, while EP lesions are typically smaller, despite its size, the patient did not experience any symptoms. EP is more commonly found in individuals between 40 and 50 years old, with a higher incidence in males. However, our patient is only 16 years old. Surgical resection is the most effective treatment, preventing malignant transformation and future complications. To the best of our knowledge, this is the first documented case of incidentally detected heterotopic pancreatic tissue in jejunum during a bariatric procedure in Syria, and it is also the fourth case in the medical literature. • An ectopic pancreas was accidentally discovered in the proximal jejunum during endoscopic bariatric surgery. • Our case showed that the lesion extended from the mucosa to the serosa without any symptoms. • An ectopic pancreas is more commonly found in individuals between 40 and 50 years old. [ABSTRACT FROM AUTHOR]

The ectopic pancreas is a benign subepithelial tumor (SET) mostly found incidentally in the stomach and duodenum. Here, we present computed tomography (CT) scans and endoscopic ultrasound (EUS) images from a 71-year-old Taiwanese man newly diagnosed with colonic adenocarcinoma. CT examination revealed a mural nodule in the proximal jejunum, with good enhancement after IV contrast medium administration. Push enteroscopy was performed to localize the lesion and evaluate its nature, and a 1 cm subepithelial lesion was found. The lesion appeared hyperechoic within the submucosal layer of the bowel wall on endoscopic ultrasound examination. A tattoo was performed, and the lesion was removed during the resection of colon cancer. The histopathology confirmed the presence of pancreatic tissue inside. As far as we know, this is the first description in the literature of an endoscopic ultrasound finding of a jejunal ectopic pancreas.

Background Choledochal cysts (CCs), congenital cystic dilatation of the biliary tract, are more commonly identified in females and have been associated with a myriad of other developmental abnormalities. Case Report: We present a male infant who was diagnosed with type I CC prenatally. He subsequently underwent cyst and gallbladder resection with hepaticoduodenostomy reconstruction at the age of 6 months. Pathologic examination confirmed type I CC with co-existing septate gallbladder and ectopic pancreas (Heinrich type 1). Conclusions: Although the clinical significance is unclear, this second case of CC with septate gallbladder and ectopic pancreas highlights the embryologic association of these abnormalities. [ABSTRACT FROM AUTHOR]

Background: Protrusion of the lateral contour of the pancreatic head is a pancreatic morphological abnormality, which is known as rare shape atypia. We present a rare case of protrusion of the lateral contour of the pancreatic head, which was challenging to distinguish from an ectopic pancreas. Case presentation: The patient was a 40-year-old man with a history of acute pancreatitis that occurred twice in the past. He complained of epigastric pain since the day before the visit; his blood workup showed high serum amylase level and a CT scan revealed a 25-mm-large mass with contrast effect from the anterior wall of the gastric pylorus to the duodenum and increased surrounding fatty tissue density. Endoscopic ultrasonography revealed a mass lesion in the gastric pylorus with continuity with the gastric wall and suspected partial continuity with the pancreatic head. Thus, the possibility of pancreatic morphological abnormality or an ectopic pancreas was considered. Following which, resection was attempted and intraoperative findings showed a wide extension of the pancreatic parenchyma from the pancreatic head to the anterior wall of the gastric pylorus to the duodenal bulb. Since the patient only had mild pancreatitis, the resection was judged to be too invasive and was completed by exploratory laparoscopy. Conclusions: Even if the findings on preoperative CT are suspicious for an ectopic pancreas or tumor, a pancreatic morphological abnormality, such as a protrusion of the lateral contour of the pancreatic head, should be included in the differential diagnosis. [ABSTRACT FROM AUTHOR]