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1
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Matran ER, Diaconu AM, Neagu O, Ulmeanu AI. Various Phenotypes of Ectopic Pancreatic Tissue in Children: Case Series and Literature Review. Diagnostics (Basel) 2025; 15:1193. [PMID: 40428186 DOI: 10.3390/diagnostics15101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 03/31/2025] [Accepted: 05/02/2025] [Indexed: 05/29/2025] Open
Abstract
Background and Clinical Significance: Ectopic pancreatic tissue (EPT), an infrequently documented condition within the pediatric population, is often asymptomatic. When clinical manifestations do occur, their severity is contingent upon the location, size, and involvement of the adjacent mucosa. Case presentation: This is a case series study, involving six children aged 15 days-13 years diagnosed with EPT from a single institution. Five of the six cases presented with both EPT and ectopic gastric tissue, located at the site of Meckel's diverticulum, while one case presented EPT exclusively, which was localized in the duodenum I. A case of Littre's hernia was identified in a newborn. Two of the six cases experienced gastrointestinal bleeding. Due to limited data on EPT in children, a comprehensive review of the literature was conducted to integrate the findings of the case series. The review synthesized evidence on clinical manifestations, diagnostic approaches, phenotypic classifications, and management strategies. Articles were identified through searches on PubMed and publisher platforms such as Elsevier and Wiley Online Library, using keywords like "ectopic pancreatic tissue", "heterotopic pancreas", and "pediatric ectopic pancreas". Conclusions: The identification of EPT continues to pose a diagnostic challenge, as the symptoms are nonspecific and can sometimes be life-threatening. Additionally, there are currently no specific paraclinical investigations available for this purpose. Histopathological evaluation remains crucial for establishing the diagnosis, which is often confirmed only after complications have arisen.
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Affiliation(s)
- Elena Roxana Matran
- Department of Paediatrics, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Pediatrics, "Grigore Alexandrescu" Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Andra-Mihaela Diaconu
- Department of Pediatrics, "Grigore Alexandrescu" Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Oana Neagu
- Department of Pathology, "Grigore Alexandrescu" Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Alexandru-Ioan Ulmeanu
- Department of Paediatrics, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Pediatrics, "Grigore Alexandrescu" Emergency Hospital for Children, 011743 Bucharest, Romania
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2
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Barila Lompe P, Gine C, Laín A, Garcia-Martinez L, Diaz Hervas M, López M. Esophageal Atresia and Gastric Ectopic Pancreas: Is There a Real Association? Eur J Pediatr Surg 2024; 34:314-318. [PMID: 37437596 DOI: 10.1055/a-2127-5672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
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.
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Affiliation(s)
| | - Carlos Gine
- Department of Pediatric Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ana Laín
- Department of Pediatric Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Maria Diaz Hervas
- Department of Pediatric Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery, Hospital Vall d'Hebron, Barcelona, Spain
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Kimsey KM, Barnett GS, Keup C, Nguyen J, Wilsey MJ, Smithers CJ, González R. Esophageal Heterotopic Pancreas in an Asymptomatic 2-Year-Old With VACTERL Association. JPGN REPORTS 2023; 4:e350. [PMID: 38034456 PMCID: PMC10684239 DOI: 10.1097/pg9.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/15/2023] [Indexed: 12/02/2023]
Abstract
A 2-year-old male with VACTERL association and asthma presented to the emergency room due to asthma exacerbation. Chest radiography revealed lingular pneumonia and thickening of the left paraspinal line of the gastroesophageal junction. Chest computed tomography confirmed a heterogeneous fluid- and gas-filled structure at the left posterior lateral posterolateral aspect of the esophagus, which was suspected to be an esophageal diverticulum on an upper gastrointestinal series. The esophageal diverticulum was excised via left thoracoscopy, and pathological examination revealed pancreatic tissue. Heterotopic pancreas lacks anatomical, vascular, or ductal continuity with the native pancreas. It is usually asymptomatic, but when discovered, it usually occurs later in life. It has been described in the foregut, but is not as common in the esophagus, especially in the pediatric population. This case report highlights the rare occurrence, and importance of considering, esophageal heterotopic pancreas within an esophageal diverticulum in an asymptomatic patient with VACTERL association.
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Affiliation(s)
| | | | - Christopher Keup
- Division of Radiology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Johnny Nguyen
- Division of Anatomic Pathology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Michael J. Wilsey
- Division of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Charles J. Smithers
- Division of Pediatric Surgery, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Raquel González
- Division of Pediatric Surgery, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
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4
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Kumar V, Gala D, Gustke C, Shah M, Bandaru P, Gayam VR, Gadaputi V, Reddy M. Pancreatic Heterotopia at the Gastroesophageal Junction: A Case Report and Review of the Literature. Cureus 2023; 15:e35830. [PMID: 37033520 PMCID: PMC10075329 DOI: 10.7759/cureus.35830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
Pancreatic heterotopia is characterized by the presence of pancreatic tissue in a location outside of its typical anatomical position. Symptoms of pancreatic heterotopia vary based on the location of the ectopic tissue. It is commonly asymptomatic and often diagnosed incidentally during routine endoscopy. Clinically significant pancreatic heterotopia is often secondary to inflammation, bleeding, obstruction, and malignant transformation. The most common location of heterotopic pancreas is within 5 cm of the pylorus usually on the greater curvature. Involvement of the gastroesophageal junction is extremely rare. In this report, we describe the case of a 57-year-old woman who was diagnosed with ectopic pancreatic tissue at the gastroesophageal junction by esophagogastroduodenoscopy after presenting with symptoms of dyspepsia.
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5
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Liou YJ, Weng SC, Chang PCY, Jiang CB, Lee HC, Chan WT, Ho CY, Wu PS, Yeung CY. Localization and Laparoscopic Excision of Gastric Heterotopic Pancreas in a Child by Endoscopic SPOT ® Tattooing. CHILDREN (BASEL, SWITZERLAND) 2023; 10:201. [PMID: 36832330 PMCID: PMC9954732 DOI: 10.3390/children10020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Heterotopic pancreas (HP) is defined as pancreatic tissue lacking vascular or anatomic connection with the normal pancreas. Surgical resection is often indicated for symptomatic gastric HP. However, intraoperative identification of gastric HP is often difficult during laparoscopic surgery. Herein, we describe a patient with gastric HP, which was marked with SPOT® dye (GI Supply, Camp Hill, PA, USA). The dye was seen clearly laparoscopically facilitating total excision of the lesion. The final pathology report confirmed the presence of heterotopic pancreatic tissue including pancreatic acini, small pancreatic ducts tissue with islets of Langerhans in the deep gastric submucosal area. There were no postoperative complications, and the patient was symptom-free. To the best of our knowledge, this was the first case report in the literature in which endoscopic tattooing of gastric HP before laparoscopic resection was performed. This method of localization was simple and reliable in children.
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Affiliation(s)
- Yu-Jung Liou
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300046, Taiwan
| | - Shu-Chao Weng
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
| | - Paul Chia-Yu Chang
- Division of Pediatric Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Hung-Chang Lee
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Wai-Tao Chan
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 104217, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei 112021, Taiwan
| | - Cheng-Yu Ho
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City 251020, Taiwan
| | - Pao-Shu Wu
- MacKay Junior College of Medicine, Nursing, and Management, Taipei 112021, Taiwan
- Department of Pathology, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Chun-Yan Yeung
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300046, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
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6
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Kechiche N, Makhlouf D, Laamiri R, Zouaoui A, Mani S, Ksiaa A, Sahnoun L, Mekki M, Belguith M, Nouri A. Intussusception Caused by Heterotopic Pancreas: A Tunisian Case Series of 5 Pediatric Patients. ARCHIVES OF IRANIAN MEDICINE 2022; 25:844-846. [PMID: 37543913 PMCID: PMC10685840 DOI: 10.34172/aim.2022.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/24/2021] [Indexed: 08/08/2023]
Abstract
Heterotopic pancreas (HP) is a rare congenital developmental anomaly of the gastro-intestinal tract, defined as the presence of pancreatic tissue found in ectopic sites. Intussusception caused by isolated HP is extremely rare. Pediatric reports concerning this pathology are case reports. Here, we report cases of secondary intussusception, in which conservative treatment failed and surgery was performed. The aim of this review is to study the epidemiologic and clinical aspects of HP in pediatric patients from our institution. We retrospectively collected patients who were treated in the pediatric surgery department for intussusception caused by HP, from January 1986 to November 2018. We investigated five patients, three boys and two girls, aged 5 months to 2 years. The diagnosis was made incidentally during the operation. HP was found in the jejunum in three cases and in the ileum in two cases. HP was removed. The postoperative course was uneventful. Although rare, HP should be included in the differential diagnosis of gastrointestinal diseases, causing secondary bowel intussusception.
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Affiliation(s)
- Nahla Kechiche
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Dorsaf Makhlouf
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Rachida Laamiri
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Arije Zouaoui
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Salma Mani
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Amine Ksiaa
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Lasaad Sahnoun
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mongi Mekki
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mohsen Belguith
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Abdellatif Nouri
- Pediatric Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
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7
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Fleischl W, Li R, Valsenti G, Foster T, Stringer MD. Duodenal pancreatic heterotopia causing acute pancreatitis with gastric outlet obstruction. ANZ J Surg 2022; 92:3078-3079. [PMID: 35178854 PMCID: PMC9790530 DOI: 10.1111/ans.17544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/01/2022] [Indexed: 12/30/2022]
Affiliation(s)
- William Fleischl
- Department of Paediatric SurgeryWellington HospitalWellingtonNew Zealand
| | - Ray Li
- Department of RadiologyWellington HospitalWellingtonNew Zealand
| | | | - Tim Foster
- Department of PaediatricsHawke's Bay HospitalHastingsNew Zealand
| | - Mark D. Stringer
- Department of Paediatric SurgeryWellington HospitalWellingtonNew Zealand,Department of Paediatrics and Child HealthUniversity of OtagoWellingtonNew Zealand
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8
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Nam SH, Han SH. Jejunal atresia due to heterotopic pancreatic intussusception. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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9
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Gastric heterotopic pancreas in children: A prospective endoscopic study. J Pediatr Surg 2020; 55:2154-2158. [PMID: 31757509 DOI: 10.1016/j.jpedsurg.2019.10.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To document the prevalence and variable appearance of gastric heterotopic pancreas (HP) in children undergoing upper gastrointestinal (GI) endoscopy. METHODS A prospective 4-year study of children undergoing flexible upper GI endoscopy in a single institution. RESULTS A total of 607 upper GI endoscopies were performed in 478 pediatric patients during the 4-year period. Eleven children (6 girls, 5 boys) aged 2.9 to 16.9 years had endoscopic features typical of gastric HP. All but one lesion was located in the gastric antrum and most appeared as an umbilicated submucosal nodule measuring 1-2 cm in diameter. Five of 13 children with repaired esophageal atresia (EA) and two of nine children with trisomy 21 had gastric HP. The prevalence of endoscopically visualized gastric HP in children without a history of EA or trisomy 21 was 1.1%. CONCLUSIONS Gastric HP is present in about 1% of pediatric upper GI endoscopies. It is significantly more common in patients with EA and may also be associated with trisomy 21. Gastric HP typically appears as a single 1-2 cm antral submucosal nodule, usually with a central pit. Recognition of this lesion is important to avoid misdiagnosis and inappropriate treatment. LEVEL OF EVIDENCE Level II (diagnostic).
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10
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Sulser P, Azarhoush S, Aronson D, Tharakan S, Zweifel N, Moehrlen U. Atypical presentations of ectopic pancreatic tissue. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Persano G, Cantone N, Pani E, Ciardini E, Noccioli B. Heterotopic pancreas in the gastrointestinal tract in children: a single-center experience and a review of the literature. Ital J Pediatr 2019; 45:142. [PMID: 31706342 PMCID: PMC6842505 DOI: 10.1186/s13052-019-0738-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Heterotopic pancreas, that is the abnormal localization of a well-differentiated pancreatic tissue, is a rare occurrence in pediatric patients. Most lesions are found incidentally; in some circumstances, the presence of heterotopic pancreas may cause gastrointestinal symptoms, such as obstructive symptoms or bleeding. Patients and methods The clinical notes of patients with histological diagnosis of heterotopic pancreas treated at Meyer Children’s Hospital between 2009 and 2017 have been retrospectively examined. Four variables have been examined: clinical presentation, age at diagnosis, timing of surgery and localization of the heterotopic pancreas. Patients have been classified accordingly. Results Fourteen patients were diagnosed with heterotopic pancreas at a single institution. In half cases, heterotopic pancreas caused symptoms that warranted surgical exploration. Symptomatic patients were significantly older than patients in whom heterotopic pancreas was an incidental finding (mean age 9 years and 5 months vs 2 years and 9 months; p = 0.02). Heterotopic pancreas was more frequently found in patients who underwent urgent surgical procedure than in patients who underwent elective surgery (2.61% vs 0.22%; p < 0.0001). In all cases, foci of heterotopic pancreas were resected. Conclusion Heterotopic pancreas is usually discovered in the submucosa of the stomach, duodenum and small bowel. Heterotopic tissue may cause symptoms related to mechanical complications, bleeding from the surrounding intestinal mucosa or, occasionally, to the development of malignancy. Heterotopic tissue is a rare but clinically relevant cause of gastrointestinal symptoms. The presence of heterotopic tissue should be considered in children with gastrointestinal symptoms of unclear origin and surgical resection is advisable.
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Affiliation(s)
- Giorgio Persano
- Department of Pediatric Surgery, IRCCS Gaslini, via Gerolamo Gaslini, 5, 16147, Genoa, Italy.
| | - Noemi Cantone
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Elisa Pani
- School of Pediatric Surgery, University of Genoa, Italy - Department of Pediatric Surgery, Meyer Children's Hospital, Florence, Italy
| | - Enrico Ciardini
- Department of Pediatric Surgery, District Hospital, Trento, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
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12
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Tang XB, Liao MY, Wang WL, Bai YZ. Mesenteric heterotopic pancreas in a pediatric patient: A case report and review of literature. World J Clin Cases 2018; 6:847-853. [PMID: 30510954 PMCID: PMC6264991 DOI: 10.12998/wjcc.v6.i14.847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/30/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
Heterotopic pancreas (HP) is a congenital anomaly defined as pancreatic tissue that has no contact with the orthotopic pancreas and its own duct system and vascular supply. The most common locations of HP are the upper gastrointestinal tract, specifically, the stomach, duodenum, and proximal jejunum. Involvement of the mesentery is rare. Here, we describe a rare case of mesenteric heterotopic pancreas (MHP) in a 12-year-old girl who presented with acute abdomen. The patient underwent emergency laparotomy, and the mass and adjacent small bowel were resected. Results of the postoperative histopathologic examination confirmed the diagnosis of MHP. Observation of the patient for 12 mo postoperatively showed no evidence of recurrence. Preoperative diagnosis of HP is difficult, even in a symptomatic patient. Increased awareness and understanding of the image characteristics of MHP will aid in correct preoperative diagnosis and appropriate patient management.
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Affiliation(s)
- Xiao-Bing Tang
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Min-Yi Liao
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wei-Lin Wang
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yu-Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
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Juricic M, Djagbare DY, Carmassi M, Panait N, Faure A, NDour O, NGom G, Merrot T. Heterotopic pancreas without Meckel's diverticulum in children as unique cause of gastrointestinal bleeding: think about it! Surg Radiol Anat 2018; 40:963-965. [PMID: 29785678 DOI: 10.1007/s00276-018-2042-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/16/2018] [Indexed: 12/27/2022]
Abstract
Ectopic pancreas also known as heterotopic pancreas (HP) is a rare congenital anomaly, mainly found as incidental finding during autopsy or abdominal exploration for an other condition. Incidence rate is probably underestimated as patients are mostly asymptomatic; otherwise, it is capable of producing symptoms depending on its location, size, often appearing in the 4th-to-6th decades. Complications such as inflammation, obstruction, bleeding, and malignancy degeneration must be considered. Pediatrics cases are very rare, generally concerning HP within Meckel's diverticulum, manifesting by gastrointestinal bleeding and intussusception. We report a rare case of jejunum bleeding, due to an isolated HP in a 15-year-old adolescent. Endoscopic and computed tomographic scan were normal, in particular did not found Meckel's diverticulum. Diagnosis and treatment have been apprehended performing a laparoscopic exploration. It is a singular location for HP, predominantly found in upper gastrointestinal tractus. So far, there have been no case reports of jejunal bleeding from ectopic pancreas without Meckel's diverticulum in children.
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Affiliation(s)
- Mélodie Juricic
- Service de Chirurgie Infantile, Hopital des Enfants, CHU Toulouse, Toulouse, France.
| | | | - Marion Carmassi
- Service d'anatomopathologie, Hôpital Nord, 13015, Marseille Cedex 20, France
| | - Nicoleta Panait
- Service de Chirurgie Infantile, Hôpital de la Timone, 13005, Marseille Cedex 20, France
| | - Alice Faure
- Service de Chirurgie Infantile, Hôpital de la Timone, 13005, Marseille Cedex 20, France
| | - Oumar NDour
- Service de Chirurgie Pédiatrique, Hôpital Aristide Le Dantec, Dakar, Senegal
| | - Gabriel NGom
- Service de Chirurgie Pédiatrique, Hôpital Aristide Le Dantec, Dakar, Senegal
| | - Thierry Merrot
- Service de Chirurgie Infantile, Hôpital de la Timone, 13005, Marseille Cedex 20, France
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14
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Heterotopic Pancreas: A Rare Cause of Gastrointestinal Bleeding in Children. Dig Dis Sci 2018; 63:1363-1365. [PMID: 29468375 DOI: 10.1007/s10620-018-4981-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/13/2018] [Indexed: 12/30/2022]
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15
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Pancreatic heterotropia in wall of extra-hepatic choledochal cysts: A retrospective analysis of thirteen of such cases from north India. Pathol Res Pract 2017; 213:1109-1111. [DOI: 10.1016/j.prp.2017.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/28/2017] [Accepted: 07/19/2017] [Indexed: 12/20/2022]
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16
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Asymmetric Hypertrophic Pyloric Stenosis with Concurrent Pancreatic Rest Presenting as Gastric Outlet Obstruction. J Pediatr 2016; 174:273-273.e1. [PMID: 27179550 DOI: 10.1016/j.jpeds.2016.03.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/24/2016] [Indexed: 01/17/2023]
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17
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Sharma S, Agarwal S, Nagendla MK, Gupta DK. Omental acinar cell carcinoma of pancreatic origin in a child: a clinicopathological rarity. Pediatr Surg Int 2016; 32:307-11. [PMID: 26694824 DOI: 10.1007/s00383-015-3850-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/30/2022]
Abstract
A 6-year-old boy presented with a large subhepatic mass associated with pain abdomen. Exploration revealed a tumor in lesser omentum, completely separate from the normal pancreas that was excised completely. Histopathology suggested acinar cell carcinoma of pancreatic origin in an ectopic location. The child is well at 5 months follow-up.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Murali Krishna Nagendla
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Devendra K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Navickas G, Valančienė D. Ektopinė (heterotopinė) kasa plonosios žarnos pasaite: klinikinio atvejo pristatymas ir literatūros apžvalga. Acta Med Litu 2016; 23:147-151. [PMID: 28356802 PMCID: PMC5088748 DOI: 10.6001/actamedica.v23i2.3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Ektopinė kasa (EK) – reta įgimta anomalija, kai normalus kasos audinys yra už kasos ribų. Heterotopinis kasos audinys plonosios žarnos pasaite yra ypač retai sutinkamas EK tipas. EK dažniausiai aptinkama įvairiose virškinamojo trakto dalyse atsitiktinai. Paprastai EK yra simptomų nesukelianti anomalija, tačiau kliniškai gali pasireikšti atsiradus komplikacijoms, tokioms kaip uždegimas, kraujavimas, obstrukcija ar supiktybėjus. Simptomų išsivystymas priklauso nuo EK dydžio, lokalizacijos bei patologinių audinio pokyčių, kurie taip pat būdingi ir normaliam kasos audiniui. Operacinis gydymas nėra indikuotinas, nebent esant komplikacijoms, todėl labai svarbi tiksli priešoperacinė diagnozė siekiant išvengti nereikalingų intervencijų. Mes pristatome retą klinikinį atvejį, kada EK lokalizavosi plonosios žarnos pasaite. Pateikiame paciento kompiuterinės tomografijos tyrimo vaizdus. Šis klinikinis atvejis parodo, kad ektopinis kasos audinys visada turėtų būti įtrauktas į gastrointestinių navikų diferencinę diagnostiką.
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Affiliation(s)
| | - Dileta Valančienė
- Vilniaus universiteto ligoninės Santariškių klinikos, Radiologijos ir branduolinės medicinos centras
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Kim SH, Nam SH. Heterotopic Pancreas Presented as Duodenal Tumor with Obstruction. Pediatr Gastroenterol Hepatol Nutr 2015; 18:280-5. [PMID: 26770904 PMCID: PMC4712542 DOI: 10.5223/pghn.2015.18.4.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/29/2015] [Accepted: 08/12/2015] [Indexed: 02/04/2023] Open
Abstract
Heterotopic pancreas (HP) is defined as pancreatic tissue lacking anatomic and vascular continuity with the main body of the pancreas. Most are asymptomatic, but can cause ulcer, bleeding, intussusception, and mechanical obstruction. Herein, we presented one case of HP presented as duodenal tumor causing duodenal obstruction. A 7-year-old girl visited the emergency room for abdominal pain with vomiting for 24 hours. Computed tomography and upper gastrointestinal series revealed a polypoid mass with short stalk in the 2nd portion of duodenum. We attempted an endoscopic removal. However, the lumen was nearly obstructed by the mass and the stalk was too broad and hard to excise. The mass was surgically removed via duodenotomy. It was confirmed as a HP with ductal and acini components (type 2 by Heinrich classification). Postoperatively, the patient has been well without any complication and recurrence.
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Affiliation(s)
- Sung Heun Kim
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - So Hyun Nam
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
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Karakus SC, Sarsu SB, Celtık C, Gokce S, Koku N. Rare causes of gastrointestinal hemorrhage in infancy. Pediatr Int 2015; 57:304-7. [PMID: 25868947 DOI: 10.1111/ped.12452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 05/04/2014] [Accepted: 07/03/2014] [Indexed: 01/04/2023]
Abstract
Gastrointestinal hemorrhage in children is a critical condition that demands quick and effective management. The differential diagnosis of gastrointestinal hemorrhage is wide. Heterotopic pancreas is a rare congenital anomaly and usually discovered incidentally. It is generally asymptomatic, but symptoms may occur when complicated by inflammation, bleeding, obstruction or malign transformation. Heterotopic pancreas may present throughout the gastrointestinal tract, but it is most commonly found in the stomach, duodenum and proximal jejunum. Juvenile polyps are common during childhood and present most often with painless rectal hemorrhage. They remain the most common colonic polyps in children. Colonoscopic polypectomy is the most effective procedure in the treatment of juvenile polyps. In this study, we describe rare causes of gastrointestinal system hemorrhage in infancy and discuss some diagnostic and therapeutic approaches.
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Filip R, Walczak E, Huk J, Radzki RP, Bieńko M. Heterotopic pancreatic tissue in the gastric cardia: A case report and literature review. World J Gastroenterol 2014; 20:16779-16781. [PMID: 25469051 PMCID: PMC4248226 DOI: 10.3748/wjg.v20.i44.16779] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/10/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
The heterotopic pancreas, which is usually described as an untypical presence of pancreatic tissue without any anatomic or vascular continuity with the pancreas, is relatively rare. Clinical manifestations may include bleeding, inflammation, pain and obstruction; however, in most cases it remains silent and is diagnosed during autopsy. Here, we report a case of ectopic pancreatic lesion located in the gastric cardia. The patient was a 73-year-old woman who had a history (over four months) of chronic epigastric pain accompanied by heartburn. Esophagogastroduodenoscopy revealed inflammatory changes throughout the stomach and lower esophagus, as well as a flat polypoid mass with benign features located in the gastric cardia, approx. 10 mm below the “Z” line, measuring approx. 7 mm in diameter. Endoscopic biopsy forceps were used to remove the lesion. Histological examination of the lesion revealed the presence of heterotopic pancreatic tissue in the gastric mucosa. On the basis of the presented case, we suggest that pancreatic ectopia should be a part of differential diagnosis, not only when dealing with submucosal gastric lesions, but also with those that are small, flat and/or untypically located.
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Huang CC, Lai MW, Hwang FM, Yeh YC, Chen SY, Kong MS, Lai JY, Chen JC, Ming YC. Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol 2014; 55:369-75. [PMID: 24685339 DOI: 10.1016/j.pedneo.2013.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/13/2013] [Accepted: 12/09/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Our objective was to analyze demographics and characteristics of Meckel's diverticulum with different manifestations in pediatric patients. METHODS This is a retrospective study in children with symptomatic Meckel's diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckel's scan results, surgical and histological findings were analyzed. RESULTS One hundred symptomatic Meckel's diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckel's scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckel's diverticulum with non-obstructive symptoms (p < 0.001). CONCLUSION Diverse presentations in pediatric Meckel's diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with non-obstructive symptoms.
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Affiliation(s)
- Chen-Chuan Huang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Fang-Ming Hwang
- Department of Education, National Chiayi University, Chiayi, Taiwan
| | - Yu-Chen Yeh
- Institute of Education, National Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jeng-Chang Chen
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Ching Ming
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kim SH, Yoo TK, Kim HY, Jung SE, Park KW. How should the pyloric submucosal mass coexisting with hypertrophic pyloric stenosis be treated?: a case of pyloric ectopic pancreas with hypertrophic pyloric stenosis. Pediatr Gastroenterol Hepatol Nutr 2014; 17:196-200. [PMID: 25349837 PMCID: PMC4209326 DOI: 10.5223/pghn.2014.17.3.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/31/2014] [Accepted: 08/18/2014] [Indexed: 11/14/2022] Open
Abstract
Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently.
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Affiliation(s)
- Soo-Hong Kim
- Department of Pediatric Surgery, Pusan National University Children's Yangsan Hospital, Yangsan, Korea
| | - Tae-Kyung Yoo
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Kwi-Won Park
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
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Kumagai H, Yokoyama K, Shimamura W, Miura Y, Yamagata T. Endoscopic ultrasonography appearance of pancreatic rest. Pediatr Int 2014; 56:654. [PMID: 25252062 DOI: 10.1111/ped.12364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 01/31/2014] [Accepted: 04/10/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
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25
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A Triad of Congenital Diaphragmatic Hernia, Meckel's Diverticulum, and Heterotopic Pancreas. Case Rep Pediatr 2014; 2014:725945. [PMID: 24804135 PMCID: PMC3996881 DOI: 10.1155/2014/725945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/06/2014] [Indexed: 11/26/2022] Open
Abstract
Congenital diaphragmatic hernia is a common developmental anomaly encountered by paediatric surgeons. It is known to be associated with extradiaphragmatic malformations, which include cardiac, renal, genital, and chromosomal abnormalities. Herein, we report a newborn born with concurrent congenital diaphragmatic hernia, Meckel's diverticulum, and heterotopic pancreatic tissue. This is the first case report of such a triad with description of possible mechanisms of the development.
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26
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Laparoscopic-assisted resection of juvenile polyp of the jejunum in a 3-year-old girl. J Pediatr Surg 2012; 47:426-9. [PMID: 22325407 DOI: 10.1016/j.jpedsurg.2011.10.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 10/10/2011] [Accepted: 10/26/2011] [Indexed: 11/22/2022]
Abstract
Sporadic juvenile polyp of the jejunum is exceedingly rare, reported only once in the English literature. We describe a 3-year-old girl with a long-lasting history of chronic iron deficiency anemia and a delayed diagnosis of jejunal polyp. The lesion was eventually discovered by ultrasonography and successfully resected using a laparoscopic-assisted transumbilical approach.
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27
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Deshpande VP, Raghunath BV, Sarin YK, Sinha S. Heterotopic pancreas causing duodenal obstruction in a patient previously treated for choledochal cyst. J Indian Assoc Pediatr Surg 2012; 17:40-42. [PMID: 22279366 PMCID: PMC3263040 DOI: 10.4103/0971-9261.91088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A 9-year-old boy presented with duodenal pancreatic rest causing obstruction and required surgical intervention. He had been treated at the age of 4 months for a choledochal cyst. Both choledochal cyst and heterotopic pancreas are entities that are commonly encountered in children, but the incidental presence of both the entities in the same child, albeit presenting metachronously, is extremely rare.
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Affiliation(s)
- Vidyanand P. Deshpande
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - B. V. Raghunath
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Yogesh K. Sarin
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Shalini Sinha
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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28
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Yang ZH, Gao JB, Yue SW, Yang XH, Guo H. Synchronous ectopic pancreatoblastoma in a child: a case report. J Korean Med Sci 2011; 26:832-5. [PMID: 21655073 PMCID: PMC3102881 DOI: 10.3346/jkms.2011.26.6.832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/28/2011] [Indexed: 11/20/2022] Open
Abstract
Pancreatoblastoma is a rare primary pancreatic neoplasm of children that may arise in any portion of the pancreas. We report a case of a 3-yr-old boy who presented to with abdominal pain our hospital and a progressive bulge in his right abdomen. Biochemical evaluation and serum levels of tumoral markers were within reference limits. On the computed tomography, two tumors were found. One located in the head of the pancreas; however, a laparotomy revealed that the head of pancreas was compressed but normal. The other was in the left abdomen near the spleen and the tail of the pancreas. The diagnosis of two synchronous pancreatoblastoma originating from the omentum was confirmed by pathology. Therefore, a pancreatoblastoma should be considered when a large well-defined, lobulated, and heterogeneous mass is identified in the pancreas of children. In addition, an ectopic pancreatoblastoma should be considered when identified within or near the ectopic pancreatic tissue.
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Affiliation(s)
- Zhi-Hao Yang
- Department of Radiology, First Affiliated Hospital of ZhengZhou University, Zhengzhou, Henan, China.
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Karaca G, Taş A, Pekceci R, Özer H, Köklü S. Unusual Cause of Severe Nausea and Vomiting in an Elderly Man: Heterotopic Pancreas. INT J GERONTOL 2011. [DOI: 10.1016/j.ijge.2011.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Mills RW, McCrudden K, Gupta VK, Britton A, Al Qahtani M, Hasan RA. Intussusception caused by heterotopic pancreatic tissue in a child. Fetal Pediatr Pathol 2011; 30:106-10. [PMID: 21391750 DOI: 10.3109/15513815.2010.524688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intussusception is the leading cause of intestinal obstruction in children and is almost invariably idiopathic. Occasionally, there is a lead point for the intussusception. Intussusception caused by heterotopic pancreas (HPT) as the lead point is exceedingly rare. We report a case of intussusception caused by HPT in a child. Clinical and pathologic features and the successful medical and surgical management of the case are discussed.
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Affiliation(s)
- Robert W Mills
- Inpatient Pediatric Services, Mercy Children's Hospital, Toledo, Ohio 43608, USA
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Abstract
OBJECTIVES Esophageal atresia with or without tracheo-esophageal fistula is a frequent malformation that occurs in about 1 of 3000 live births. It can be associated with other congenital malformations. The aim of this study was to measure the frequency of heterotopic pancreas (HP) in children with esophageal atresia (EA) and to evaluate possible linkage with other malformations. MATERIALS AND METHODS All patients with EA were prospectively followed since 2005 at Hôpital Sainte-Justine and since 2006 at the Montreal Children's Hospital. We compared 91 patients who underwent gastroscopy during that period with 182 control patients who submitted to gastroscopy for other indications. The presence or the absence of HP and its localization were noted in both groups. The following data were also collected on patients with EA: sex, gestational age, EA type, and other malformations. RESULTS Seventeen (18.7%) of the 91 patients with EA had gastric HP compared with 1 (0.5%) in the control group (OR 42, 95% confidence interval 7-249, P < 0.001). There were no differences between patients with or without HP regarding sex, prematurity, EA type, and the presence or absence of other congenital abnormalities. CONCLUSIONS This study demonstrates, for the first time, that gastric HP is associated with EA irrespective of other malformations.
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Heterotopic pancreas of the esophagus and stomach associated with pure esophageal atresia. J Pediatr Surg 2010; 45:E25-7. [PMID: 20223305 DOI: 10.1016/j.jpedsurg.2009.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 12/19/2009] [Accepted: 12/21/2009] [Indexed: 11/22/2022]
Abstract
Esophageal atresia with or without tracheoeosphageal fistula is a frequent congenital malformation that may be associated with other congenital anomalies. The combination of heterotopic pancreas of the esophagus and pure esophageal atresia, however, is rare. We treated a patient with esophageal atresia without tracheoesophageal fistula (type A) associated with heterotopic pancreas of the esophagus and stomach who developed a gastric perforation.
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Heterotopic pancreas-an unusual cause of melena in a pediatric patient. J Pediatr Surg 2009; 44:2432-3. [PMID: 20006044 DOI: 10.1016/j.jpedsurg.2009.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 09/12/2009] [Accepted: 09/15/2009] [Indexed: 11/21/2022]
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Xiao WD, Chen W, Yang H. Heterotopic Pancreas within Meckel's Diverticulum with Obscure then Massive Gastrointestinal Bleeding in a 12-year-old Child: Case Report and Review of the Literature. J Int Med Res 2009; 37:967-72. [PMID: 19589283 DOI: 10.1177/147323000903700343] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We report a case of a 12-year-old boy with heterotopic pancreas (HP) located in a Meckel's diverticulum (MD) and presenting as obscure gastrointestinal (GI) bleeding. Upper GI endoscopy and colonoscopy did not reveal the source of the bleeding, however, capsule endoscopy revealed a space-occupying lesion in the ileum. The patient developed massive bleeding and an emergency exploratory laparotomy was performed. A congested MD was discovered 100 cm from the ileocaecal valve using intra-operative endoscopy; the ulcerated tip of the diverticulum appeared to be the source of the bleeding. The MD and adjacent ileal segment were resected and an end-to-end anastomosis performed. Subsequent pathological examination revealed an ileal MD with HP tissue within the submucosa. The patient remains well, 12 months after the operation, with no evidence of recurrent bleeding. This case suggests that HP should be considered as one possible cause of obscure GI bleeding in children and capsule endoscopy is a valuable adjuvant tool in the diagnosis of HP in children.
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Affiliation(s)
- W-D Xiao
- Department of General Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - W Chen
- Department of Microbiology, Third Military Medical University, Chongqing, China
| | - H Yang
- Department of General Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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35
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Dahshan A. Bleeding Meckel diverticulum responds to intravenous pantoprazole. South Med J 2007; 24:416-22. [PMID: 17396746 DOI: 10.1002/ca.21094] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 10/03/2010] [Accepted: 10/14/2010] [Indexed: 01/25/2023]
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