Gastric perforation and generalized peritonitis due to heterotopic pancreas, an unusual case report

Heterotopic pancreas is the presence of normal pancreatic tissue that is in an anatomical site different from the pancreas.

Adolescent who was admitted to the emergency room due to intense, generalized abdominal pain, which did not go away with anything, was exacerbated with movements, 24 h later vomiting that occurred as soon as he ate food was added, and severe and progressive abdominal distention, reason for admission to the service of emergencies. He had no significant family or personal medical history. On physical examination, he was found to be sick with a painful appearance, pale, sweaty, feverish, with tachycardia, he complained of intense pain, distended abdomen, with loss of hepatic dullness, with involuntary muscular resistance, with positive rebound sign, absent peristalsis. Laboratory studies were taken that reported anemia, leukocytosis and neutrophilia, blood chemistry, electrolytes, and coagulation times within normal limits; abdominal x-rays showed subdiaphragmatic free air.

The prevalence of pancreatic heterotopia in the literature varies from 0.6 % in autopsy series to 14 %, however, the increasingly frequent use of upper gastrointestinal endoscopy and endoscopic ultrasound allows early diagnosis, since whether directed or incidentally, which avoids serious complications such as gastric perforation, because it is unusual for it to occur as in this clinical case. Specifically in the stomach, involvement of the submucosa layer has been described in 73 %, muscular layer in 17 % and subserosa in 10 % of cases respectively. In cases where the disease is in an asymptomatic stage, it can be treated conservatively; it seems to be more common in men, as in our case, than in women.

In patients with chronic epigastric pain, it is essential to rule out conditions such as heterotopic pancreas, to avoid serious complications such as perforation.