1704 A Case of Heterotopic Pancreas Discovered in the Distal Esophagus

Abstract

INTRODUCTION: Heterotopic pancreas (HP) is a congenital abnormality that represents ectopic pancreatic tissue that does not have anatomic, vascular or ductal continuity. The incidence is hard to determine, however, the prevalence of HP is 0.55% to 13.7% on autopsy, 0.2% to 0.5% of abdominal operations, and 0.9% of gastrectomies. HP is most commonly found in the stomach, duodenum, proximal jejunum and rarely, in the esophagus. Approximately 15 cases have been reported in the literature of HP located in the esophagus. CASE DESCRIPTION/METHODS: We present a case of a 70-year-old male with a past medical history significant for hypertension, hypercholesterolemia, melanoma, and atrial fibrillation who underwent an esophagogastroduodenoscopy (EGD) for evaluation of heartburn and nausea. Incidentally a 5 mm polypoid appearing lesion in the distal esophagus above the gastroesophageal junction was found. Biopsy results are usually nondiagnostic, however, in our patient, histology revealed squamous mucosa with active esophagitis and associated cardiac-type mucosa with focal pancreatic heterotopia and chronic inflammation in the distal esophagus. DISCUSSION: Complications may result from undiagnosed cases of HP including benign or malignant transformation of tissue, pseudocyst formation, pancreatitis, gastrointestinal bleeding, ulceration, gastric outlet obstruction, or intussusception. Treatment depends on the symptom and location. In asymptomatic patients, simple observation may be sufficient, however in patients with symptoms or complications, surgical or Ivor-Lewis Esophagectomy, or laparoscopic resection is recommended. In our case, the patient’s symptoms were treated conservatively with a proton pump inhibitor successfully.