Related Experiment Videos
Heterotopic pancreas as lead point in intussusception: new variant of vitellointestinal tract malformation
R Abel1, C E Keen, J B Bingham
1Department of Paediatric Surgery, University Hospital Lewisham, London SE13 6LH, UK.
Insights
Heterotopic pancreas, a rare cause of intussusception, involves pancreatic tissue in the ileum. This condition, potentially originating from the vitellointestinal tract, can lead to intestinal blockages in children.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Surgical Pathology
Background:
- Intussusception is a common cause of intestinal obstruction in infants and young children.
- Heterotopic pancreas, defined as pancreatic tissue found outside its normal location, is an uncommon anomaly.
- Ectopic pancreatic tissue is typically asymptomatic and most frequently found in the upper gastrointestinal tract.
Observation:
- Two pediatric cases of intussusception are presented, where the lead point was identified as heterotopic pancreatic tissue in the ileum.
- The first case involved ileoileal intussusception with a 12-mm pancreatic nodule at the apex of the intussusceptum.
- The second case presented with ileocolic intussusception, and histopathology revealed a 10-mm pancreatic nodule in the ileal serosa.
Findings:
- Both cases demonstrated fully formed pancreatic tissue, including acinar cells, islets, and ductal structures, within the ileal serosa.
- Ectopic gastric mucosa was present in the draining duct or intestinal opening in both patients.
- The heterotopic pancreatic tissue in these cases is proposed to be of vitellointestinal tract origin, analogous to a Meckel's diverticulum.
Implications:
- Heterotopic pancreas is a rare but significant cause of intussusception in children.
- Early diagnosis and surgical intervention are crucial for managing intussusception caused by this anomaly.
- Understanding the origin of heterotopic pancreatic tissue may offer insights into congenital gastrointestinal anomalies.
Abstract:
Two cases of intussusception are reported with heterotopic pancreatic tissue attached to and draining into the ileum. The first patient, a boy aged 16 months, presented with ileoileal intussusception. The diagnosis was confirmed on ultrasound scan. Laparotomy and resection were performed. A 12-mm nodule of heterotopic pancreatic tissue was identified in the ileal serosa at the apex of the intussusceptum, fully formed with acinar tissue, islets, and draining duct. The second patient, also a boy aged 16 months, presented with obstructed ileocolic intussusception in which the lead point at surgery resembled a Meckel's diverticulum. Histopathology revealed a similar 10-mm nodule of fully formed pancreatic tissue in the ileal serosal tissues, with some acinar tissue extending through the wall of the intestine alongside ductal structures. In both cases there was ectopic gastric mucosa either in the distal part of the draining duct or in the small intestine itself at the opening. Heterotopic pancreas is a rare cause of intussusception. We propose that this lesion is of vitellointestinal tract origin, conceptually similar to a Meckel's diverticulum but without a diverticulum as such. Heterotopic pancreatic tissue occurring alone is more common in the proximal small intestine, duodenum, and stomach than in the ileum, and it is often asymptomatic.