Heterotopic pancreas - An expert in hide and seek

Area of Science:

• Gastroenterology
• Surgical Pathology
• Diagnostic Imaging

Background:

• Heterotopic pancreas is a rare congenital anomaly where pancreatic tissue is found outside its normal location.
• Common sites include the upper gastrointestinal tract, but thoracic, splenic, and renal locations are exceptionally rare.
• Most patients with heterotopic pancreas are asymptomatic, complicating early diagnosis.

Observation:

• A patient presented with postprandial abdominal pain and weight loss, with imaging revealing a duodenal growth.
• Standard imaging and PET scans did not show metabolic activity, posing diagnostic challenges.
• Surgical intervention (laparotomy, small bowel resection) was performed due to symptomatic presentation.

Findings:

• Histopathological examination (HPE) confirmed the presence of heterotopic pancreas.
• Heterotopic pancreas can mimic other gastrointestinal pathologies and may lead to complications like pancreatitis or malignancy.
• Diagnostic tools like endoscopy and CT imaging have limitations in detecting these anomalies.

Implications:

• This case highlights the diagnostic challenges associated with heterotopic pancreas, especially in symptomatic individuals.
• Early recognition of common locations and imaging characteristics is crucial for diagnosis.
• Surgical resection is the definitive management for symptomatic heterotopic pancreas.