Abstract
Ectopic pancreas is a rare embryological abnormality apparently not in association with others. Stomach and duodenum are the most common organs involved. Symptoms are nonspecific. Patients may complain of dyspepsia, abdominal pain or intestinal obstruction. Malignant evolution of ectopic pancreatic cells has been reported. Diagnosis can be very challenging due to the rarity of the disease and the absence of specific symptoms and radiological findings. We report two cases of young-adult men admitted to the emergency department due to acute upper gastro-intestinal and pancreatic symptoms. In both cases, during upper gastrointestinal endoscopy no mucosal vegetations were found. Endoscopic ultrasonography revealed gastric lesions originating from the muscularis propria, with a pattern suspected but not conclusive for malignancy. Fine needle aspiration was inconclusive in both cases. The patients underwent abdominal computed tomography, that showed gastric masses originating from the antrum and the lesser curvature of the stomach, with enlarged locoregional lymph nodes. According to the patients’ symptoms, family history, radiological and cytological findings, the patients were scheduled for an explorative laparoscopy. In both cases, gastric ectopic pancreas was found. Clinical presentation of ectopic pancreas is heterogeneous and the diagnosis can be challenging, especially in an emergency setting. Endoscopic ultrasonography and fine needle aspiration can be useful for the diagnosis and clinical staging, but they can be unspecific. Diagnostic-therapeutic laparoscopy should be considered in symptomatic patients.
Highlights
The incidence of ectopic pancreas is 0.6–13%, according to autoptic findings [1]
Endoscopic ultrasonography revealed gastric lesions originating from the muscularis propria, with a pattern suspected but not conclusive for malignancy
Endoscopic ultrasonography and fine needle aspiration can be useful for the diagnosis and clinical staging, but they can be unspecific
Summary
The incidence of ectopic pancreas is 0.6–13%, according to autoptic findings [1]. In 90% of the cases, it is found in the submucosal and muscularis propria of the upper gastrointestinal tract, especially in the stomach and the duodenum [2]. We performed an abdominal computed tomography (CT scan) that showed an 8 x 4 x 5 cm mass originating from the gastric antrum in the lesser curvature, with both fluid and solid well vascularized components and some enlarged celiac and mesocolic lymph nodes According to his symptoms, his personal history, the radiological and cytological findings exploratory laparoscopy was indicated. In consideration of clinical presentation and unclear first imaging findings, to rule out the suspicion of pancreatitis, an abdominal CT scan was performed 48 hours later (Figure 2): no pancreatic abnormalities were found, while a diffuse gastric wall thickening with a 2 x 3 cm intraparietal nodule in the lesser curvature and some enlarged locoregional lymph nodes were detected. At clinical follow-up one month later, the patients were asymptomatic and well, and their blood tests were unremarkable
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