Abstract

background

Heterotopic Pancreas (HP) is a rare embryological deformity that is characterized by pancreatic growth that is lacking vascular and anatomical connection to the main pancreas (1). There are two theories for its proposed mechanism: the poor position and metaplasia theories (1, 3). The first postulates that a portion from the primitive pancreas is left behind during embryological intestinal rotation. The second poses a foci of metaplasia that migrates independently during embryogenesis (1). Regardless, the incidence is 0.25-13.7% worldwide (3). Most are found on postmortem autopsy but can present as melena, vomiting, abdominal pain, constipation/diarrhea and GERD (2, 3). Although the malignant potential of an ectopic pancreas is less than the normal one, surgical resection is the only curative treatment (4). Future complications include pancreatitis, pseudo-cyst propagation and malignancy (4).

case presentation We present a case of a 27-year-old German-Cuban male who presents to the ED with intermittent sharp lower abdominal pain for the past 2 months. Symptoms have been progressively getting worse and associated with nausea, non-bloody, non-bilious vomiting, and non-bloody diarrhea. CT abdomen/pelvis without contrast (figure 3), Urinalysis, CBC, CMP was performed on admission and confirmed an ileo-ileal intussusception and mild anemia. Patient was referred to general surgery where an exploratory laparotomy showed an 8 cm tan, hemorrhagic friable mass within the small bowel lumen with three enlarged mesenteric lymph nodes. A fresh frozen section was taken and confirmed to be non-malignant, ulcerated pancreatic tissue (figure 1). Patient recovered nicely post-operatively and was discharged. discussion

This case report highlights a unique etiology of intussusception. Adult account for 5% of total number of Intussusceptions, with intestinal locations being very rare (3). This additional pancreas is also called aberrant, choristoma, heterotopic, or accessory (1, 4). The patient’s pathology report showed the uncommon Type 1 Heinrich criteria (Figure 2). Furthermore, its ileal location is also unusual (2). Although an uncommon diagnosis, it should be considered in all patients who present with an obstruction. This patient presented with a larger lesion that acted as a lead point and progressively worsened until the patient obtained long-term health insurance and sough treatment.

conclusion

This case represents a rare but interesting differential. HP is usually asymptomatic and found during surgery for unrelated reasons or post- mortem. While most lesions are subserosa, this lesion was intraluminal hence why it presented with symptoms. It is truly unique to have encountered this case.

References

1. DOI: 10.7759/cureus.14586-1
2. DOI: 10.30699/IJP.14.2.180
3. DOI: 10.3748/wjg.15.3964
4. DOI: 10.21037/acr.2019.07.05
5. DOI: 10.12998/wjcc.v10.i7.2261
6. DOI: 10.1016/j.ijscr.2018.03.023