S1393 Heterotopic Pancreas in the Hepatic Flexure of the Colon

Abstract

INTRODUCTION: Heterotopic pancreas (HP) is a normal pancreatic tissue in an aberrant anatomic location. It is usually defined as pancreatic tissue that has neither anatomic nor vascular continuity with the normally located pancreas. The HP can present at any age and could be found in multiples locations, being the upper gastrointestinal (GI) tract the more frequent, in 70–90% of the cases. The incidence is reported from 0.5% to 15 % in necropsy series and 1 every 500 patients in surgical series. The presenting symptoms vary from asymptomatic to some patients developing abdominal pain, pancreatitis, or gastrointestinal obstruction. CASE DESCRIPTION/METHODS: 61 years-old Female referred by her PCP with a positive FOBT and sporadic episodes of nausea without vomiting, associated with generalized mild abdominal pain and distention in the last 3 months. Past medical history was positive for breast cancer 1 year ago, controlled at that moment. Previous Esophagus-gastroduodenoscopy (EGD) was normal 3 years ago and previous colonoscopy 5 years-ago was positive for resected benign polyps. No family history of GI conditions. She denied any macroscopic bloody stool or change in her bowel movements. On physical exam, the abdomen was soft, NT/ND, BS present, and no hepatomegaly. EGD was done and reported as normal. Colonoscopy reported internal hemorrhoids, first degree; flat polyp of 5 mm in rectum with successful polypectomy by cold snare and it was sent for biopsy, and in hepatic flexure was founded a 2 mm villous appearing area, umbilicated, with drainage from the center (Image 1 and 2), an endoclip was placed x1 in the vicinity for radiological marking and it was resected and sent it for biopsy. The biopsy from polyp reported tubular adenoma, negative for high-grade dysplasia or carcinoma. The biopsy from hepatic flexure reported pancreatic heterotopia. CT of abdomen and pelvis was informed as normal. The patient had uncomplicated progress and was followed up in the clinic with improvement in her symptoms. DISCUSSION: The HP in the colon is extremely unusual being the stomach and small bowel the more frequent locations. Similar to other cases, our patient’s symptoms improved after been resected the HP. On endoscopy, it appears as a submucosal nodule with a central umbilication and drainage through the center (Image 1 and 2) as described in other cases. The diagnosis was confirmed by pathology.Image 1.Image 2.