Acute Small Intestinal Obstruction Caused by Ectopic Pancreas. A Clinical Case Report

Abstract

Introduction. An ectopic pancreas is an abnormality in which pancreatic tissue has grown outside its normal location with its own blood supply and ducts while having no anatomical, vascular or innervation connections with the pancreas situated normally. The accessory pancreas is the most frequent congenital disorder of this gland. The pancreatic tissue can be found in the walls of stomach, intestine, gallbladder, Meckel’s diverticulum, the liver, spleen and, seldom, in other organs having no contact with the pancreas. Currently the ectopic pancreas incidence is on the rise and amounts up to 0.2% on average in abdominal surgeries and is reported in 0.5–13% of autopsy cases. Most frequently the aberrant pancreas is located in the gastroduodenal zone (63–70% of all the heterotopic pancreas cases); most often it is found in the pylorus and antrum (85–95% of all the gastric ectopic pancreas cases).Materials and methods. This paper presents a case of a successful treatment of a 39 year old male with an acute small intestinal obstruction caused by ectopic pancreatic tissue in the intestinal wall. The patient received a diagnostic laparoscopy and a mid-midline laparotomy with the wedge resection of the small intestine.Results.The postoperative period was recorded as uneventful; the patient was discharged home on day nine following the surgery after removal of cutaneous sutures. The pathology of the small intestinal fragment with the polyp-like neoplasm identified heterotypic pancreatic foci (with acini and ducts) located between muscular bands, with extensive areas of haemorrhaging and necrosis.Conclusion.The diagnosis of the ectopic pancreas tissue in intestinal wall is an extremely complex issue in abdominal surgery; this diagnosis is normally made only when complications occur. Pathomorphological verification is of paramount importance to make the final diagnosis of this disease, making it possible to identify correctly the cause and mechanism of the development of an acute surgical disorder.