Interventional endoscopic ultrasound for a symptomatic pseudocyst secondary to gastric heterotopic pancreas

Abstract

Heterotopic pancreas (HP) is a relatively uncommon entity that is defined as pancreatic tissue without a true anatomical or vascular connection to the pancreas. HP does not cause symptoms in most cases but can occasionally produce various manifestations, including nausea, vomiting, abdominal pain, and even heterotopic pancreatitis. Here, we report an unusual case in which heterotopic pancreatitis complicated by the formation of a pseudocyst that caused gastric outlet obstruction was diagnosed based on serum hyperamylasemia and findings from endoscopic ultrasonography (EUS)-guided fine needle aspiration (EUS-FNA) cytology. EUS-guided single pigtail stent insertion was successfully performed for recurrent gastric outlet obstruction. The patient has remained healthy and symptom-free during 4 years of surveillance. In the context of the relevant literature, the described case is a rare case of HP complicated by a pseudocyst treated via EUS-FNA and stent insertion.

Keywords: Heterotopic pancreas; Pseudocyst; Gastric outlet obstruction; Endoscopic ultrasound-guided fine needle aspiration

Core tip: Heterotopic pancreas (HP), which is defined as the atypical presence of pancreatic tissue without an anatomical or vascular connection to the pancreas, is relatively rare. As an intra- or submucosal lesion, HP is typically asymptomatic and found incidentally. We report a case involving a 40-year-old man with gastric outlet obstruction secondary to pseudocyst formation in HP.