Ileo-ileal intussusception and gastrointestinal bleeding caused by incidental heterotopic pancreas: four case reports

Heterotopic pancreas (HP) is a developmental anomaly defined as aberrantly located pancreatic tissue with no anatomical, vascular, or neural connection to the pancreas. Bowel intussusception and gastrointestinal bleeding caused by isolated HP is extremely rare. This study explores the clinical, radiographical, pathologic, and treatment features of four patients with intussusception caused by incidental HP, with the aim of providing important insight into the diagnosis and management of these patients. In this paper, the charts of four patients who underwent emergency laparotomy between January 2013 and August 2015 at the First Affiliated Hospital of Zhejiang University, China were reviewed. Patient demographics, presenting symptoms, blood test results, pre-operative imaging, operative procedure, and histopathology were retrospectively reviewed. All four patients, including three males and one female, presented to the emergency room with severe abdominal pain and melena. Routine blood tests revealed hemoglobin levels ranging from 75 to 128 g/L. Contrast-enhanced computed tomography (CT) confirmed lesions involving the ileum with intussusception and bowel obstruction, and all cases immediately underwent emergency laparotomy. All cases were subsequently diagnosed with HP according to histopathology. HP should therefore be considered as a rare but possible differential diagnosis for gastrointestinal bleeding and bowel intussusception, and as a possible cause of these conditions.