Heterotopic pancreas - An expert in hide and seek

Heterotopic pancreas is rare and difficult to diagnose pre-operatively. Common sites for heterotopic pancreas such as the upper gastrointestinal tract, rarely involve the thorax, spleen, and kidney. Endoscopy imaging and CT imaging have been advocated to aid in diagnosis; however, they still present challenges. The majority of heterotopic pancreas patients are asymptomatic.

Our patient presented left-sided abdominal pain intermittently, each time after meals, with weight loss over the past three months. Imaging showed a small intraluminal growth at the posterior wall of the duodenum, with no metabolic activity detected from the PET scan. Given the symptomatic presentation, we proceeded with laparotomy and small bowel resection with primary anastomosis. HPE confirmed the presence of a heterotopic pancreas. Here, we discuss the management of the heterotopic pancreas and provide a literature review.

The heterotopic pancreas shares a similar genetic makeup, physiological function, and local environment exposure as the pancreas. Similar complications, such as acute or chronic pancreatitis, abscesses, pseudocyst formation, and, rarely malignancy can also occur in the heterotopic pancreas. It is often difficult to detect a heterotopic pancreas. Factors such as the site, size, and characteristics of the lesion usually aid in diagnosis, whether through endoscopy or imaging. Biopsies can be taken via endoscopy if the lesion is accessible, but most biopsies are non-diagnostic.

Heterotopic pancreas is rare and challenging to diagnose. Knowledge of common locations and characteristic imaging appearances of heterotopic pancreatic tissue aids in diagnosing. The definitive treatment is surgical resection.