Ectopic Pancreas

1
Ectopic Pancreas

• A congenital anomaly found in the
  gastrointestinal tract or adjacent structures
• Heterotopic pancreas, aberrant pancreas,
  accessory pancreas
• Klob demonstrated the existence of ectopic
  pancreas histologically in 1859.
• The term of pancreatic heteropia by Barbosa et
  al. in 1946.

2
Definition

• Defined as pancreatic tissue found in other than
  its usual location and having no anatomic or
  vascular connection with the pancreas itself
  (Martinez et al., 1958)

3
Incidence

• The reported surgical incidence one case in
  every 500 upper abdominal explorations (Barbosa
  et al., 1946)
• Incidence estimated have ranged from 0.55 to
  13.7 in various autopsy analyses (Barbosa et
  al., 1946 Feldman and Weinberg, 1952)

4
Ectopic Pancreas

• More common in men(Barbosa et al., 1946 Nakao et
  al., 1980 Armstrong et al., 1981)
• Ectopic pancreas is most frequently seen in the
  duodenum (28), the stomach (26) or the jejunum
  (16) in several autopsy series. (Krieg, 1941
  Barbosa et al., 1946 Pearson, 1951 Dolan et
  al., 1974)

5
Ectopic Pancreas

• It has been found in many unusual sites,
  including ileum (3), ileal or jejunal
  diverticula (3, 0.4, respectively), Meckel's
  diverticulum (5), the gallbladder or bile ducts,
  umbilicus, Fallopian tube, and in a mediastinal
  teratoma ( Lai and Tompkins, 1986
  Fenoglio-Preiser et al., 1980 Barbosa et al.,
  1946)

6
Clinical Manifestations

• Most patients are asymptomatic
• Non-specific symptoms such as abdominal pain,
  epigastric discomfort, nausea and vomiting,
  bleeding and others(Kaneda et al., 1989)
• 40-68 of cases are symptomatic (Anseline et al.,
  1981)
• Epigastric pain is the most common presenting
  symptom

7
Clinical Manifestations

• The symptoms that may occur depend on the site of
  the lesion
• Other manifestations gastric outlet obstruction,
  intussusception, intestinal obstruction, acute
  pancreatitis, gastrointestinal bleeding, common
  bile duct obstruction with obstructive jaundice,
  the Zollinger-Ellison syndrome, chronic
  pancreatitis with pseudocyst formation, body
  weight loss, and malignant degeneration

8
Histological Types

• Heinrich (1909) classified ectopic pancreas into
  three histological types
• Type I a typical pancreatic tissue with acini,
  ducts and islet cells like a normal pancreas
• Type II composed of a pancreatic tissue with a
  large number of acini and a few ducts lacking
  islet cells

9
Histological Types

• Type III a pancreatic tissue with a lot of ducts
  and a few acini without islet cells

10
Diagnosis

• Diagnosis of ectopic pancreas is difficult even
  with the improvement of radiologic, endoscopic,
  and routine biopsy procedure.
• Pre-operative diagnosis of ectopic pancreas is
  suggested during upper gastrointestinal series
  when a small, umbilicated mass is seen along the
  distal greater curvature of the stomach.

11
Diagnosis

• Amylase, lipase analysis
• Differential diagnosis of endoscopy findings or
  radiological findings leiomyoma, leiomyosarcoma,
  melanoma, carcinoid , polyp, lymphoma

12
Treatment

• Ectopic pancreas is believed to be a benign
  condition, therefore, only local excision, if
  needed, is sufficient for symptomatic cure.
• Surgical treatment symptomatic and complications
  developed
• Long term follow up

13
Conclusion

• Proximal enteroscopy increases the diagnostic
  yield by 37.6 when evaluating the upper
  gastrointestinal bleeding. When used judiciously,
  it is a very good alternative examination.
  Immediate biopsies and local treatment can be
  done under direct vision. (J Intern Med Taiwan
  19989126-130)