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Diffuse Peritonitis due to Perforated Gastric Ectopic Pancreas.
Nobutada Fukino1, Takatsugu Oida, Kenji Mimatsu
1Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan.
Case Reports in Gastroenterology
|November 28, 2012
Summary
Ectopic pancreas, pancreatic tissue outside the pancreas, rarely causes gastric perforation. This case highlights the importance of considering ectopic pancreas in patients with sudden, severe abdominal pain and signs of perforation.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Imaging
Background:
- Ectopic pancreas, pancreatic tissue found outside the pancreas, is a rare congenital anomaly.
- Most ectopic pancreas cases are asymptomatic or present with nonspecific gastrointestinal symptoms.
- Gastric perforation is an extremely rare but serious complication of ectopic pancreas.
Observation:
- A 68-year-old woman presented with acute, severe right upper quadrant and flank abdominal pain.
- Physical examination revealed rebound tenderness and abdominal distension, with laboratory tests indicating inflammation.
- Abdominal CT scan showed free air, ascites, and gastric antrum/pylorus adipose tissue elevation, suggesting upper gastrointestinal perforation.
Findings:
- Urgent surgery identified a 25 mm perforation on the lesser curvature of the gastric antrum.
- Microscopic analysis of the perforation site revealed ectopic pancreatic tissue (Type I Heinrich's criteria).
- Extensive gastric resection with Billroth II reconstruction was performed; the postoperative course was uneventful.
Implications:
- This case underscores the extreme rarity of gastric perforation caused by ectopic pancreas.
- Clinicians should consider ectopic pancreas in the differential diagnosis of gastric perforation, especially in atypical presentations.
- Prompt surgical intervention and accurate pathological diagnosis are crucial for managing this rare complication.
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