Heterotopic Pancreas in Distal Yeyunum as a Cause of Hematoquexia

Abstract

Introduction: Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of hematochezia and melena. Method: Case report of a 64-year old women with 5 episodes of hematochezia over a period of 18 months. Clinic pathological correlation, evolution and resolution. Result: Patient underwent initial upper endoscopy on his first episode and panendoscopy and colonoscopy on the subsequent episodes with no findings of hemorrhage. She had 1-2.5 gramS decrease in every event. After the last episode she underwent capsule endoscopy where it was detected a 1.5cm polyp at distal yeyunum. Laparoscopic enterectomy was done with no new episode of hematochezia at 1 year. Conclusion: Heterotopic pancreas should be considered as a diferential diagnosis in hematochezia and melena. Jean-Schultz was the first to report that heterotopic pancreas is pancreatic tissue found outside the usual anatomical location of the pancreas. It is a congenital abnormality. The incidence rate is 0.11%-0.21% at autopsy, with a male to female ratio of 3:1. Heterotopic pancreas can exist at any position in the abdominal cavity. It is usually found in the upper gastrointestinal tract, with > 90% of the cases involving the stomach, duodenum or jejunum. Heterotopic pancreas is usually buried in the submucosa. The diameter of heterotopic pancreatic tissue is generally about 1-2 cm