Gastroenterologie
a hepatologie

Ectopic pancreas as a cause of upper gastrointestinal bleeding

Michal Vacík¹, Filip Shon², Miroslav Řežábek³

+ Affiliation
¹ Gastroenterologické oddělení, Nemocnice České Budějovice, a. s.
² Gastroenterologické oddělení, Nemocnice České Budějovice, a.s.
³ Patologické oddělení, Nemocnice České Budějovice, a. s

Summary

Differentiated ectopic pancreatic tissue can develop anywhere in the gastrointestinal tract (GIT) and is most frequently found in the gastric or duodenal wall. Nowadays a development of ectopic pancreas stay unclear. The incidence of an ectopic pancreas is 0.55–13.70%, and such tissue is found more frequently in males than in females. Most ectopic pancreases are histologically categorized as type 1 according to Heinrich’s classification and contain all pancreatic components (acini, ducts, and endocrine cells). The majority of cases are asymptomatic; however, a large ectopic pancreas can cause various symptoms. Ectopic pancreatic tissue rarely causes bleeding. Here, we present two case reports. The first case was a middle-aged woman who developed anemia due to ectopic pancreatic tissue in the gastric wall. The second case exhibited acute bleeding due to a subpapillary lesion in the duodenum. Differential diagnosis can be difficult. Surgery and histological examination of the resected GIT led to a definitive diagnosis in both cases.

Keywords

surgery, choristoma, ectopic tissue, endoscopy, gastrointestinal tract, bleeding, pancreas

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Literature

1. Wlaź J, Mądro A, Kaźmierak W et al. Pancreatic and gastric heterotopy in the gastrointestinal tract. [online]. Available from: http: //www.phmd.pl/api/files/view/29653.pdf4.
2. Betzler A, Mees ST, Pump J et al. Clinical impact of duodenal pancreatic heterotopia – Is there a need for surgical treatment? BCM Surg 2017; 17: 53. doi. 10.1186/s12893-017-02 50-x.
3. Gottschalk U, Dietrich CF, Jenssen C. Ectopic pancreas in the upper gastrointestinal tract: is endosonographic diagnosis reliable? Data from the German Endoscopic Ultrasound Registry and review of the literature. Endosc Ultrasound 2018; 7 (4): 270–278.
4. Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran‘s gastrointestinal and liver disease. Saunders: Elsevier 2010: 918–919.
5. Bromberg SH, Neto CC, Borges AF et al. Pancreatic heterotopias: clinicopathological analysis of 18 patients. Rev Col Bras Cir 2010; 37 (6): 413–419.
6. Heinrich H. Ein Beitrag zur Histologie des sogen. akzessorischen Pankreas. Virchows Arch Pathol Anat Physiol Klin Med 1909; 198 (3): 392–401.
7. Gaspar Fuentes A, Campos Tarrech JM, Fernández Burgui JL et al. Pancreatic ectopias. Rev Esp Enferm Apar Dig 1973; 39 (3):  255–268.
8. Faulx AI, Kothari S, Acosta RD et al. The role of endoskopy in subepithelial lesions of the GI tract. Gastrointest Endosc 2017; 85 (6): 1117–1131. doi: 10.1016/j.gie.2017.02.022.
9. Dumonceau JM, Polkowski M, Larghi A et al. Indikace, výsledky a klinický dopad endosonograficky (EUS) – navigovaného odběru v gastroenterologii: klinická doporučení Evropské společnosti pro gastrointestinální endoskopie (ESGE). [online]. Dostupné z: http: //www.endoskopiste.cz/wp-content/uploads/2017/07/indikace-eus-fnab.pdf.
10. Kliment M. Diagnostika aberantního pankreatu pomocí EUS-FNA. Kolonoskopie 2010. [online]. Dostupné z: http: //www.kolonoskopie.cz/pripad-mesice/2010/kveten-1/diagnostika-aberantniho-pankreatu-pomoci-eus-fna.aspx.